Provider Demographics
NPI:1376083972
Name:PAOLA CASANOVA, MD, PLLC
Entity Type:Organization
Organization Name:PAOLA CASANOVA, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-951-6884
Mailing Address - Street 1:3145 NE 184TH ST APT 5303
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2467
Mailing Address - Country:US
Mailing Address - Phone:954-909-7979
Mailing Address - Fax:305-357-3683
Practice Address - Street 1:3145 NE 184TH ST APT 5303
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-2467
Practice Address - Country:US
Practice Address - Phone:954-909-7979
Practice Address - Fax:305-357-3683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115874261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty