Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 036076 | CA |
NPI | 1104048909 |
---|---|
Provider Name | Dr. Regina D Minutello |
First Address | Riverside, CA 92503-9702 |
Second Address | Corona, CA 92879-3122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |