Individual
JOHN REGIS MINOTTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 11TH ST, LAKEPORT, CA 95453-4100
(707) 263-3746
Mailing address
801 11TH ST, LAKEPORT, CA 95453-4100
(707) 263-3746
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
C39966
CA
207RI0011X
Interventional Cardiology Physician
C39966
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C399660
BLUE SHIELD OF CALIFORNIA
CA
05
—
00C399660
—
CA
01
—
060067540
RAILROAD MEDICARE
CA
Enumeration date
07/13/2005
Last updated
03/09/2020
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