Provider Demographics
NPI:1710974589
Name:MINTEN, LUAUNA ELAINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:LUAUNA
Middle Name:ELAINE
Last Name:MINTEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7160 BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2614
Mailing Address - Country:US
Mailing Address - Phone:951-782-3725
Mailing Address - Fax:951-782-6204
Practice Address - Street 1:7160 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2614
Practice Address - Country:US
Practice Address - Phone:951-782-3725
Practice Address - Fax:951-782-6204
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282684163W00000X
CANP8000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ14801ZOtherGROUP SITE LOCATION
1730180415OtherGROUP NPI NUMBER
ZZZ14801ZOtherGROUP SITE LOCATION
ZZZ14818ZMedicare ID - Type Unspecified