Provider Demographics
NPI:1437230463
Name:CASANOVA, ROBERTO L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:L
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 1:735 AVE PONCE DE LEON STE 809
Mailing Address - Street 2:TORRE MEDICA AUXILIO MUTUO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5031
Mailing Address - Country:US
Mailing Address - Phone:787-274-1282
Mailing Address - Fax:787-764-0898
Practice Address - Street 1:735 AVE PONCE DE LEON STE 809
Practice Address - Street 2:TORRE MEDICA AUXILIO MUTUO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5031
Practice Address - Country:US
Practice Address - Phone:787-274-1282
Practice Address - Fax:787-764-0898
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12594207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081464OtherMEDICARE ID