Healthcare Provider Details

I. General information

NPI: 1639373277
Provider Name (Legal Business Name): RENEE CAROLE MINJAREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 116TH AVE NE SUITE 305
BELLEVUE WA
98004-4623
US

IV. Provider business mailing address

1135 116TH AVE NE SUITE 305
BELLEVUE WA
98004-4623
US

V. Phone/Fax

Practice location:
  • Phone: 425-453-1772
  • Fax: 425-453-0603
Mailing address:
  • Phone: 206-592-5000
  • Fax: 206-824-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLL16254
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD60158478
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: