Healthcare Provider Details

I. General information

NPI: 1710011085
Provider Name (Legal Business Name): SEAN AUGUSTINE MINJARES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WASHINGTON ST
BOSTON MA
02111-1526
US

IV. Provider business mailing address

61 BROOKLINE AVE APT 209
BOSTON MA
02215-3406
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-4663
  • Fax: 617-636-4852
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number219172
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA100054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: