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General NPI Number Information
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NPI Number | 1104048909
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Entity Type | Individual
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Provider Name | DR. REGINA D MINUTELLO
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 770 MAGNOLIA AVE STE 2E
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City | CORONA
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State | CA
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Zip | 92879-3122
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Country | US
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Telephone | 951-279-7847
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Fax | 951-279-7422
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Provider Business Mailing Address
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Address Line | 16574 BRIGHTRIDGE LN
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City | RIVERSIDE
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State | CA
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Zip | 92503-9702
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Country | US
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Telephone | 951-359-1472
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Fax | 951-279-7422
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 036076
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License Number State | CA
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