Healthcare Provider Details

I. General information

NPI: 1568426161
Provider Name (Legal Business Name): DEEPIKA MINNAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 STONY POINT RD STE 17
SANTA ROSA CA
95407-6848
US

IV. Provider business mailing address

32 BRIGHTON CT
SANTA ROSA CA
95403-1709
US

V. Phone/Fax

Practice location:
  • Phone: 707-578-2005
  • Fax:
Mailing address:
  • Phone: 972-978-8884
  • Fax: 707-573-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM0181
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberC175740
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC175740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: