Provider Demographics
NPI:1144221383
Name:SANTA MINA, REYNALDO B (MD)
Entity Type:Individual
Prefix:
First Name:REYNALDO
Middle Name:B
Last Name:SANTA MINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 TERNHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-2454
Mailing Address - Country:US
Mailing Address - Phone:916-418-4884
Mailing Address - Fax:
Practice Address - Street 1:3480 TERNHAVEN WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-2454
Practice Address - Country:US
Practice Address - Phone:916-418-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA677782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A677780Medicaid
CA00A677780Medicaid
CAWA67778AMedicare ID - Type Unspecified