Provider Demographics
NPI:1871647396
Name:MINUTOLI, ANDREW CHARLES (RN)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:CHARLES
Last Name:MINUTOLI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4491 STONE CANYON CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-4403
Mailing Address - Country:US
Mailing Address - Phone:925-689-4949
Mailing Address - Fax:
Practice Address - Street 1:1420 WILLOW PASS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5223
Practice Address - Country:US
Practice Address - Phone:925-646-5480
Practice Address - Fax:925-646-5622
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469785163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult