Provider Demographics
NPI:1326239732
Name:MINKS, JOBETH C (BS)
Entity Type:Individual
Prefix:
First Name:JOBETH
Middle Name:C
Last Name:MINKS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 E SUPERSTITION SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-4001
Mailing Address - Country:US
Mailing Address - Phone:480-641-4051
Mailing Address - Fax:
Practice Address - Street 1:483 W. SEED FARM ROAD
Practice Address - Street 2:
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85147
Practice Address - Country:US
Practice Address - Phone:602-528-1200
Practice Address - Fax:602-271-7870
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ678993133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered