Healthcare Provider Details

I. General information

NPI: 1710974589
Provider Name (Legal Business Name): LUAUNA ELAINE MINTEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7160 BROCKTON AVE
RIVERSIDE CA
92506-2614
US

IV. Provider business mailing address

7160 BROCKTON AVE
RIVERSIDE CA
92506-2614
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-3725
  • Fax: 951-782-6204
Mailing address:
  • Phone: 951-782-3725
  • Fax: 951-782-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number282684
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP8000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: