Provider Demographics
NPI:1841606100
Name:HUMBERTO CASANOVA MD PA
Entity Type:Organization
Organization Name:HUMBERTO CASANOVA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-827-3388
Mailing Address - Street 1:17670 NW 78TH AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3664
Mailing Address - Country:US
Mailing Address - Phone:305-827-3388
Mailing Address - Fax:305-827-4008
Practice Address - Street 1:17670 NW 78TH AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3664
Practice Address - Country:US
Practice Address - Phone:305-827-3388
Practice Address - Fax:305-827-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83737261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262886401Medicaid
FL262886401Medicaid