MEDICARE: REYNALDO B SANTA MINA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	A67778	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144221383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REYNALDO B SANTA MINA MD

Provider Business Mailing Address
First Line	:	3480 TERNHAVEN WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-2454
Country	:	US
Telephone Number	:	916-418-4884
Fax Number	:

Provider Business Practice Location Address
First Line	:	3480 TERNHAVEN WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-2454
Country	:	US
Telephone Number	:	916-418-4884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	09/21/2009

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