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General NPI Number Information
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NPI Number | 1629027214
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Entity Type | Organization
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Legal Business Name | MINERVA SANTO TOMAS MD PA
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 6419 SW 40TH ST
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City | MIAMI
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State | FL
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Zip | 33155-4827
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Country | US
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Telephone | 305-774-5677
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Fax | 305-774-5697
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Provider Business Mailing Address
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Address Line | 6419 SW 40TH ST
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City | MIAMI
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State | FL
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Zip | 33155-4827
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Country | US
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Telephone | 305-774-5677
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Fax | 305-774-5697
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Authorized Official
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Title or Position | PHYSICIAN/ OWNER
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Name | DR. MINERVA SANTO TOMAS
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Credential | M.D.
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Telephone | 305-774-5677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME 70314
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License Number State | FL
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