Provider Demographics
NPI:1871741348
Name:MINASOVA, VIKTORIYA RANTIKOVNA (RRT)
Entity type:Individual
Prefix:
First Name:VIKTORIYA
Middle Name:RANTIKOVNA
Last Name:MINASOVA
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 W CARIBBEAN LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4882
Mailing Address - Country:US
Mailing Address - Phone:480-828-6747
Mailing Address - Fax:
Practice Address - Street 1:2916 W CARIBBEAN LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4882
Practice Address - Country:US
Practice Address - Phone:480-828-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-26912225700000X
AZ6888227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1871741343Medicaid