Provider Demographics
NPI:1568651560
Name:CASANOVA, MAGIN INOCENCIO (MD)
Entity Type:Individual
Prefix:
First Name:MAGIN
Middle Name:INOCENCIO
Last Name:CASANOVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PASEO LOS CORALES I
Mailing Address - Street 2:564 C/ GOLFO DE MEXICO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-654-8465
Mailing Address - Fax:787-654-7444
Practice Address - Street 1:BO ALMIRANTE NORTE
Practice Address - Street 2:CARR 160 KM 4.5
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-654-8465
Practice Address - Fax:787-654-7444
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2018-09-07
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Provider Licenses
StateLicense IDTaxonomies
PR16906208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice