=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861713836
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT SANTA CRUZ, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2010
-----------------------------------------------------
Last Update Date | 06/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11760 SW 40TH ST SUITE 654
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-3582
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-559-9696
-----------------------------------------------------
Fax | 305-559-1316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11760 SW 40TH ST SUITE 654
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-3582
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-559-9696
-----------------------------------------------------
Fax | 305-559-1316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. MONICA T ORENSTEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-559-9696
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME104791
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------