Provider Demographics
NPI:1790721256
Name:CASOLA, GIOVANNA (MD)
Entity Type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:
Last Name:CASOLA
Suffix:
Gender:F
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:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:858-249-6749
Mailing Address - Fax:
Practice Address - Street 1:200 WEST ARBOR DR
Practice Address - Street 2:MAIL CODE 8756
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8756
Practice Address - Country:US
Practice Address - Phone:619-543-6633
Practice Address - Fax:619-543-3781
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG515752085P0229X, 2085R0202X, 2085R0204X, 2085U0001X, 2085B0100X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ096413Medicaid
CA00G515750Medicaid
CA00G515750Medicaid
CAWG51575AMedicare ID - Type Unspecified
CAWG51575BMedicare ID - Type Unspecified