Provider Demographics
NPI:1649538786
Name:MINAIE, ARASH (DO)
Entity type:Individual
Prefix:
First Name:ARASH
Middle Name:
Last Name:MINAIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:707-573-5261
Mailing Address - Fax:707-573-5414
Practice Address - Street 1:34 MARK WEST SPRINGS RD STE 310
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1783
Practice Address - Country:US
Practice Address - Phone:707-573-5261
Practice Address - Fax:707-573-5414
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16216207RP1001X, 207RC0200X
TXQ4811207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A16216OtherSTATE MEDICAL LICENSE