1780919514 NPI number — DR. CAMILO FEDERICO CASANOVA MD

Table of content: DR. CAMILO FEDERICO CASANOVA MD (NPI 1780919514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780919514 NPI number — DR. CAMILO FEDERICO CASANOVA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASANOVA
Provider First Name:
CAMILO
Provider Middle Name:
FEDERICO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780919514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 174TH ST
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
SUNNY ISLES BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33160-3206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-597-1132
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE INDEPENDENCIA # 136
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTIAGO
Provider Business Practice Location Address State Name:
SANTIAGO
Provider Business Practice Location Address Postal Code:
51000
Provider Business Practice Location Address Country Code:
DO
Provider Business Practice Location Address Telephone Number:
809-881-4444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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