Provider Demographics
NPI:1659335198
Name:RASALAN, MINERVA M (MD)
Entity Type:Individual
Prefix:
First Name:MINERVA
Middle Name:M
Last Name:RASALAN
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 1:1350 S HICKORY ST
Mailing Address - Street 2:SUITE 3 G-16
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3224
Mailing Address - Country:US
Mailing Address - Phone:321-434-7243
Mailing Address - Fax:321-434-8744
Practice Address - Street 1:1350 S HICKORY ST
Practice Address - Street 2:SUITE 3 G-16
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:321-434-7243
Practice Address - Fax:321-434-8744
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1026802080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine