Provider Demographics
NPI:1275829459
Name:CASANOVA, HERIBERTO (MD)
Entity Type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:CASANOVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CALLE GEORGETOWN
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4018
Mailing Address - Country:US
Mailing Address - Phone:305-772-5550
Mailing Address - Fax:
Practice Address - Street 1:300 CALLE GEORGETOWN
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4018
Practice Address - Country:US
Practice Address - Phone:305-772-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12855-I208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery