DOMINIC J MINTALUCCI (NPI# 1114126869) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1114126869 |
Entity Type | Individual |
Full Name | DOMINIC J MINTALUCCI |
Credential | M.D. |
Practice Address |
1405 Montgomery Dr Santa Rosa CA 95405-4557 |
Practice Telephone | 7075461922 |
Practice Fax Number | 7075461897 |
Mailing Telephone | 7075461922 |
Mailing Fax Number | 7075461897 |
Enumeration Date | 2007-07-13 |
Last Update Date | 2013-10-04 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgery | A126421 | CA | Allopathic & Osteopathic Physicians |
Y | 207XS0106X |
Orthopaedic Surgery Specialization: Hand Surgery |
A126421 | CA | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
CA | LICENSE | A126421 | 01 |
Street Address |
1405 MONTGOMERY DR |
City | SANTA ROSA |
State | CA |
Zip Code | 95405-4557 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1750365102 | Michael James Mcdermott | Orthopaedic Surgery | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 | 2005-11-30 |
1487118105 | Rodney Gerrit Dekleuver | Physician Assistant | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 | 2019-01-27 |
1083010813 | Nadine Raymond | Occupational Therapist | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 | 2014-11-05 |
1043471279 | Christian Nabil Athanassious | Orthopaedic Surgery | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 | 2008-06-20 |
1720272313 | Neema Pourtaheri | Orthopaedic Surgery | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 | 2007-08-28 |
1891997227 | Jennifer Henshaw-lefever | Occupational Therapist | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 | 2007-06-05 |
1164637922 | Santa Rosa Orthopaedic Medical Group, Inc. | Orthopaedic Surgery | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 | 2007-05-14 |
1477765931 | Robert J Smith | Physician Assistant | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 | 2007-05-04 |
1588876049 | Patricia K Hall | Physical Therapist | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 | 2007-05-04 |
1821200395 | Christopher T Krug | Physical Therapist | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 | 2007-05-04 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1083230486 | Lizett Camacho | Counselor | 145o Neotomas Avenue Suite 200, Santa Rosa, CA 95405 | 2020-06-22 |
1346768918 | Ingrid Tsong | Student in an Organized Health Care Education/Training Program | 3447 Summerfield Road, Santa Rosa, CA 95405 | 2017-09-05 |
1275051898 | Jessica Peters Malmberg | Student in an Organized Health Care Education/Training Program | 2447 Summerfield Rd, Santa Rosa, CA 95405 | 2017-09-04 |
1306246772 | Kirsten Eckert | Advanced Practice Midwife | 500 Doyle Park Dr Suite 103, Santa Rosa, CA 95405 | 2014-09-03 |
1982034294 | Mohammad Reza Saeidi | Dentist | 1820 Sonoma Ave Ste 90a, Santa Rosa, CA 95405 | 2013-11-22 |
1851631642 | Debi M. Emmons | Marriage & Family Therapist | 2447 Summerfield Dr, Social Advocates for Youth, Santa Rosa, CA 95405 | 2013-02-15 |
1841549979 | Karie Louise Klim | Marriage & Family Therapist | 182 Farmers Ln Ste 204, Santa Rosa, CA 95405 | 2012-09-05 |
1427314400 | Rachel E. Page | Counselor | 2447 Summerfield Rd., Santa Rosa, CA 95405 | 2012-04-04 |
1689991572 | Center for Integral Healing Inc. | Community Health Worker | 182 Farmers Lane, #203, Santa Rosa, CA 95405 | 2010-04-30 |
1588997647 | Kai Morgan | Dentist | 1144 Suite 116 Soonoma Ave, Santa Rosa, CA 95405 | 2009-09-08 |
Find all providers in zip 95405 |
Taxonomy Code | 207XS0106X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Orthopaedic Surgery |
Specialization | Hand Surgery |
An orthopaedic surgeon trained in the investigation, preservation and restoration by medical, surgical and rehabilitative means of all structures of the upper extremity directly affecting the form and function of the hand and wrist. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1437713500 | Santa Rosa Orthopaedic Medical Group, Inc. | Orthopaedic Surgery | 34 Mark West Springs Rd Ste 300, Santa Rosa, CA 95403-1783 | 2019-04-24 |
1164637922 | Santa Rosa Orthopaedic Medical Group, Inc. | Orthopaedic Surgery | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 | 2007-05-14 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1477027050 | Bay Area Surgical Specialists | Orthopaedic Surgery | 2505 Samaritan Dr Ste 208, San Jose, CA 95124-4008 | 2019-01-16 |
1316484504 | James Angus Turner | Orthopaedic Surgery | 2190 Washington St, Suite 404, San Francisco, CA 94109-2869 | 2017-01-25 |
1477906717 | Phuc Dang, Md Corporation | Orthopaedic Surgery | 1006 Mission Dr Apt A, Suite 200, Costa Mesa, CA 92626-4217 | 2016-07-21 |
1528423506 | H. Relton Mccarroll Jr. Md A Medical Corporation | Orthopaedic Surgery | 2351 Clay St Ste 510, San Francisco, CA 94115-1931 | 2015-12-17 |
1598174492 | Paul J. Casey, Md Inc | Orthopaedic Surgery | 969 Blue Heron, Seal Beach, CA 90740-5611 | 2014-08-05 |
1023428901 | Austin Arlo Pitcher | Orthopaedic Surgery | 3315 Broadway Fl 1, Oakland, CA 94611-5717 | 2014-05-01 |
1932547536 | Hassan Jon Azimi | Orthopaedic Surgery | 8008 Frost St Ste 403, San Diego, CA 92123-4209 | 2013-06-06 |
1114265949 | Wayne Pan | Orthopaedic Surgery | 1475 Grandview Dr, Ms 354-g, Room 354171, South San Francisco, CA 94080-4901 | 2013-01-29 |
1720348162 | Ryu Yoshida | Orthopaedic Surgery | 8635 W 3rd St Ste 990w, Los Angeles, CA 90048-6116 | 2012-05-19 |
1285933424 | Anna Marie Acosta | Orthopaedic Surgery | 1760 Termino Ave Ste 308, Long Beach, CA 90804 | 2011-03-25 |
Find all providers with the same taxonomy |
City | SANTA ROSA |
Zip Code | 95405 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.