Provider Demographics
NPI:1720391287
Name:MIAMI CARDIOVASCULAR PREVENTION INSTITUTE
Entity type:Organization
Organization Name:MIAMI CARDIOVASCULAR PREVENTION INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MINERVA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOTOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-774-5677
Mailing Address - Street 1:PO BOX 144396
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114
Mailing Address - Country:US
Mailing Address - Phone:305-774-5677
Mailing Address - Fax:305-774-5697
Practice Address - Street 1:6419 SW BIRD ROAD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-774-5677
Practice Address - Fax:305-774-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043067207R00000X
FLME70314207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254617500Medicaid
96497OtherBC/BS
FL047928400Medicaid
32733OtherBC/BS
FLA62332Medicare UPIN
96497OtherBC/BS