Provider Demographics
NPI:1609944248
Name:MINOW, ROBERT A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:MINOW
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 1:3801 KATELLA AVE
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3338
Mailing Address - Country:US
Mailing Address - Phone:562-598-9745
Mailing Address - Fax:562-430-8707
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:SUITE # 207
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3338
Practice Address - Country:US
Practice Address - Phone:562-598-9745
Practice Address - Fax:562-430-8707
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2012-09-26
Deactivation Date:2011-05-02
Deactivation Code:
Reactivation Date:2012-09-26
Provider Licenses
StateLicense IDTaxonomies
CAG20754207RH0003X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41055Medicare UPIN