Provider Demographics
NPI:1568426161
Name:MINNAL, DEEPIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPIKA
Middle Name:
Last Name:MINNAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BRIGHTON CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1709
Mailing Address - Country:US
Mailing Address - Phone:972-978-8884
Mailing Address - Fax:707-573-5430
Practice Address - Street 1:711 STONY POINT RD STE 17
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-6848
Practice Address - Country:US
Practice Address - Phone:707-578-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0181208000000X
CAC175740202D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine