Healthcare Provider Details

I. General information

NPI: 1760757892
Provider Name (Legal Business Name): RAISA MARIE PINTO MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SMITH AVE N STE 300
SAINT PAUL MN
55102-2383
US

IV. Provider business mailing address

6451 N FEDERAL HWY STE 800
FORT LAUDERDALE FL
33308-1409
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-5111
  • Fax:
Mailing address:
  • Phone: 954-837-2362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number69723
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number69723
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number307234
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number69723
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: