Active NPI
Regina D Minutello
- Periodontics
- Corona, CA
National Provider Identifier
1104048909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 036076
- Practice address
- 770 Magnolia Ave Ste 2E
Corona, CA 92879-3122 - Phone
- (951) 279-7847
- Fax
- (951) 279-7422
- NPI assigned
- May 2, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 036076 | CA | Primary |
Addresses
Primary practice location
770 Magnolia Ave Ste 2E
Corona, CA 92879-3122
Mailing address
16574 Brightridge LN
Riverside, CA 92503-9702
Phone (951) 359-1472
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036076 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104048909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16574 BRIGHTRIDGE LN",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925039702",
"telephone_number": "951-359-1472",
"fax_number": "951-279-7422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "770 MAGNOLIA AVE STE 2E",
"city": "CORONA",
"state": "CA",
"postal_code": "928793122",
"telephone_number": "951-279-7847",
"fax_number": "951-279-7422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINUTELLO",
"first_name": "REGINA",
"middle_name": "D",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "036076",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.