Provider Demographics
NPI:1790311892
Name:CASANOVA, ROBERTO
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
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:VENUS GARDENS PLAZA SUITE 16
Mailing Address - Street 2:AVE ACUARIO 19
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-761-4990
Mailing Address - Fax:787-748-1935
Practice Address - Street 1:VENUS GARDENS PLAZA SUITE 16
Practice Address - Street 2:AVE ACUARIO 19
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-761-4990
Practice Address - Fax:787-748-1935
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist