Provider Demographics
NPI:1134580913
Name:CASENAVE, EMILIO (IDC)
Entity type:Individual
Prefix:MR
First Name:EMILIO
Middle Name:
Last Name:CASENAVE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6031 SANDY SHORE CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-1014
Mailing Address - Country:US
Mailing Address - Phone:305-399-3752
Mailing Address - Fax:
Practice Address - Street 1:6031 SANDY SHORE CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-1014
Practice Address - Country:US
Practice Address - Phone:305-399-3752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman