Individual
DOMINIC J MINTALUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1405 MONTGOMERY DR, SANTA ROSA, CA 95405-4557
(707) 546-1922
(707) 546-1897
Mailing address
1405 MONTGOMERY DR, SANTA ROSA, CA 95405-4557
(707) 546-1922
(707) 546-1897
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
A126421
CA
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
A126421
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A126421
LICENSE
CA
Enumeration date
07/13/2007
Last updated
10/04/2013
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