Provider Demographics
NPI:1184669871
Name:MINKUS, ROXANA P (DO)
Entity Type:Individual
Prefix:DR
First Name:ROXANA
Middle Name:P
Last Name:MINKUS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 S BRISTOL ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5751
Mailing Address - Country:US
Mailing Address - Phone:714-800-1919
Mailing Address - Fax:714-800-1924
Practice Address - Street 1:2650 S BRISTOL ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704
Practice Address - Country:US
Practice Address - Phone:714-800-1919
Practice Address - Fax:714-800-1924
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6672207Q00000X, 261QP2300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOAX6672ON61Medicaid
CAOOAX66720Medicaid
CAG01215Medicare UPIN