Provider Demographics
NPI:1629481809
Name:RENE CASANOVA MEDICAL OFFICE, INC
Entity Type:Organization
Organization Name:RENE CASANOVA MEDICAL OFFICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-202-5137
Mailing Address - Street 1:1881 N UNIVERSITY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8923
Mailing Address - Country:US
Mailing Address - Phone:954-516-0070
Mailing Address - Fax:
Practice Address - Street 1:1881 N UNIVERSITY DR STE 103
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8923
Practice Address - Country:US
Practice Address - Phone:954-516-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264910101Medicaid
FLF70640Medicare UPIN
FL264910101Medicaid