Provider Demographics
NPI:1184717704
Name:CASANOVA, EFREN (MD)
Entity type:Individual
Prefix:
First Name:EFREN
Middle Name:
Last Name:CASANOVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8711 E PINNACLE PEAK PMB 203
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3517
Mailing Address - Country:US
Mailing Address - Phone:602-336-5351
Mailing Address - Fax:602-569-8308
Practice Address - Street 1:8711 E PINNACLE PEAK RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3517
Practice Address - Country:US
Practice Address - Phone:602-336-5351
Practice Address - Fax:602-569-8308
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ729262Medicaid
AZG82273Medicare UPIN