Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A67205 | CA |
NPI | 1912029919 |
---|---|
Provider Name | Dr. Matthew Dominic Mingrone |
First Address | Los Gatos, CA 95031-0687 |
Second Address | San Francisco, CA 94104-4546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 14/08/2012 |