Healthcare Provider Details

I. General information

NPI: 1942363296
Provider Name (Legal Business Name): MAURICE ANTHONY MINERVINI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ALHAMBRA BLVD SUITE 210
SACRAMENTO CA
95816-5241
US

IV. Provider business mailing address

1201 ALHAMBRA BLVD SUITE 210
SACRAMENTO CA
95816-5241
US

V. Phone/Fax

Practice location:
  • Phone: 916-731-7775
  • Fax: 916-731-7785
Mailing address:
  • Phone: 916-731-7775
  • Fax: 916-731-7785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number20A6087
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6087
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: