Provider Demographics
NPI:1972099455
Name:CASANOVAS RIVERO, ALBERTO DAMIAN (SA-C, IMG)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:DAMIAN
Last Name:CASANOVAS RIVERO
Suffix:
Gender:M
Credentials:SA-C, IMG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10730 SW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3619
Mailing Address - Country:US
Mailing Address - Phone:786-805-9818
Mailing Address - Fax:
Practice Address - Street 1:10730 SW 38TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3619
Practice Address - Country:US
Practice Address - Phone:786-805-9818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-08
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-187246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant