Provider Demographics
NPI:1699730978
Name:SANTO TOMAS, MINERVA (MD)
Entity type:Individual
Prefix:MS
First Name:MINERVA
Middle Name:
Last Name:SANTO TOMAS
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 1:6419 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4827
Mailing Address - Country:US
Mailing Address - Phone:305-774-5677
Mailing Address - Fax:305-774-5697
Practice Address - Street 1:6419 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4827
Practice Address - Country:US
Practice Address - Phone:305-774-5677
Practice Address - Fax:305-774-5697
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-70314174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254617500Medicaid
FL254617500Medicaid
FLG07453Medicare UPIN