Provider Demographics
NPI:1912972985
Name:MINOSA, MARIA RUBY R (MD)
Entity Type:Individual
Prefix:
First Name:MARIA RUBY
Middle Name:R
Last Name:MINOSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:M. RUBY
Other - Middle Name:
Other - Last Name:MINOSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5691
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:191 S BUENA VISTA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4554
Practice Address - Country:US
Practice Address - Phone:855-723-3005
Practice Address - Fax:855-817-9681
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A527270Medicaid
CA00A527270Medicaid
CAG00074Medicare UPIN
CAWA52727JMedicare PIN