Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | A28026 | CA |
NPI | 1023282134 |
---|---|
Provider Name | Dr. Gilbert Mintz |
First Address | Redlands, CA 92373-6143 |
Second Address | Palm Desert, CA 92260-4134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2008 |
Last Update Date | 28/01/2010 |