Provider Demographics
NPI:1306918131
Name:ROTHBARD, MINDY BUFF (MD)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:BUFF
Last Name:ROTHBARD
Suffix:
Gender:F
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:PO BOX 160341
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-9998
Mailing Address - Country:US
Mailing Address - Phone:916-201-5645
Mailing Address - Fax:
Practice Address - Street 1:202 SELBY RANCH RD
Practice Address - Street 2:APT. 8
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5811
Practice Address - Country:US
Practice Address - Phone:916-201-5645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA668802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A668800Medicaid
00A668800Medicare ID - Type Unspecified
H51023Medicare UPIN