MEDICARE: MINERVA SANTO TOMAS MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME 70314	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629027214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINERVA SANTO TOMAS MD PA

Provider Business Mailing Address
First Line	:	6419 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-4827
Country	:	US
Telephone Number	:	305-774-5677
Fax Number	:	305-774-5697

Provider Business Practice Location Address
First Line	:	6419 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-4827
Country	:	US
Telephone Number	:	305-774-5677
Fax Number	:	305-774-5697

Authorized Official
Title or Position	:	PHYSICIAN/ OWNER
Name	:	DR. MINERVA SANTO TOMAS
Credential	:	M.D.
Telephone Number	:	305-774-5677

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	11/20/2007

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