Provider Demographics
NPI:1518696905
Name:CASANOVA, JOSE IGNACIO
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:IGNACIO
Last Name:CASANOVA
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 1:220 NE 12TH AVE LOT 85
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6230
Mailing Address - Country:US
Mailing Address - Phone:786-379-9899
Mailing Address - Fax:
Practice Address - Street 1:220 NE 12TH AVE LOT 85
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6230
Practice Address - Country:US
Practice Address - Phone:786-379-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician