Healthcare Provider Details

I. General information

NPI: 1649538786
Provider Name (Legal Business Name): ARASH MINAIE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MARK WEST SPRINGS RD STE 310
SANTA ROSA CA
95403-1783
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 707-573-5261
  • Fax: 707-573-5414
Mailing address:
  • Phone: 707-573-5261
  • Fax: 707-573-5414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ4811
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number20A16216
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number20A16216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: