Healthcare Provider Details

I. General information

NPI: 1609944248
Provider Name (Legal Business Name): ROBERT A MINOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date: 05/02/2011
Reactivation Date: 09/26/2012

III. Provider practice location address

3801 KATELLA AVE SUITE # 207
LOS ALAMITOS CA
90720-3338
US

IV. Provider business mailing address

3801 KATELLA AVE SUITE # 207
LOS ALAMITOS CA
90720-3338
US

V. Phone/Fax

Practice location:
  • Phone: 562-598-9745
  • Fax: 562-430-8707
Mailing address:
  • Phone: 562-598-9745
  • Fax: 562-430-8707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG20754
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG20754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: