Provider Demographics
NPI:1063815629
Name:CASANAS, GILBERTO
Entity Type:Individual
Prefix:MR
First Name:GILBERTO
Middle Name:
Last Name:CASANAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8241 SW 12TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4343
Mailing Address - Country:US
Mailing Address - Phone:305-951-6503
Mailing Address - Fax:
Practice Address - Street 1:8241 SW 12TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4343
Practice Address - Country:US
Practice Address - Phone:305-951-6503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBMO 84540247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist