Healthcare Provider Details

I. General information

NPI: 1184669871
Provider Name (Legal Business Name): ROXANA P MINKUS D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 S BRISTOL ST SUITE 105
SANTA ANA CA
92704
US

IV. Provider business mailing address

2650 S BRISTOL ST STE 105
SANTA ANA CA
92704-5751
US

V. Phone/Fax

Practice location:
  • Phone: 714-800-1919
  • Fax: 714-800-1924
Mailing address:
  • Phone: 714-800-1919
  • Fax: 714-800-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number20A6672
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6672
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A6672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: