Healthcare Provider Details

I. General information

NPI: 1639018385
Provider Name (Legal Business Name): CARA ELIZABETH MINOR RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CALIFORNIA ST STE 1400
SAN FRANCISCO CA
94104-2116
US

IV. Provider business mailing address

5808 HIDDEN LN
EDINA MN
55436-2049
US

V. Phone/Fax

Practice location:
  • Phone: 212-589-2700
  • Fax:
Mailing address:
  • Phone: 262-989-6640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number5893
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: