Individual provider Active NPI

Marlon Minera, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Riverside, CA
National Provider Identifier
1306367958
Registry record updated Feb 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
A169462 Issued in CA
Practice address
17130 Van Buren Blvd # 1007
Riverside, CA 92504-5905
Phone
(951) 476-3239
Fax
(951) 584-3080
NPI assigned
Jul 5, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X A169462 CA Primary

Addresses

Primary practice location

17130 Van Buren Blvd # 1007
Riverside, CA 92504-5905

Mailing address

17130 Van Buren Blvd # 1007
Riverside, CA 92504-5905
Phone (951) 476-3239

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210419000915 CA Practitioner - Hospice/Palliative CarePractitioner - Geriatric Medicine 7618203530 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A169462CAMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Jan 21, 2021 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jan 21, 2021 Accepting new patients
Marlon Minera, M.D., Inc. Geriatric Medicine CurrentSince Sep 1, 2025 Accepting new patients

Locations

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

10800 Magnolia Ave
#3
Riverside, CA 92505
Phone (951) 353-2000

8133 Magnolia Ave
Riverside, CA 92504
Phone (951) 688-4321

10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000

17130 Van Buren Blvd
Riverside, CA 92504
Phone (951) 441-7649

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771804800000",
    "number": "1306367958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17130 VAN BUREN BLVD # 1007",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925045905",
            "telephone_number": "951-476-3239",
            "fax_number": "951-584-3080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17130 VAN BUREN BLVD # 1007",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925045905",
            "telephone_number": "951-476-3239",
            "fax_number": "951-584-3080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINERA",
        "first_name": "MARLON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-05",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A169462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.