Provider Demographics
NPI:1396786497
Name:MINTZ, ALAN C (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:C
Last Name:MINTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 CUYAMA RD
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2419
Mailing Address - Country:US
Mailing Address - Phone:805-279-8040
Mailing Address - Fax:
Practice Address - Street 1:2190 LYNN RD
Practice Address - Street 2:STE 320
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8026
Practice Address - Country:US
Practice Address - Phone:805-279-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG964312086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G694312Medicaid
CAG69431AMedicare ID - Type Unspecified
CA00G694312Medicaid