Provider Demographics
NPI:1508841008
Name:CASANOVA, LAIDA N (MD)
Entity Type:Individual
Prefix:DR
First Name:LAIDA
Middle Name:N
Last Name:CASANOVA
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 1:11040 N KENDALL DR
Mailing Address - Street 2:SUITE# C-100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1272
Mailing Address - Country:US
Mailing Address - Phone:305-596-9979
Mailing Address - Fax:305-598-0063
Practice Address - Street 1:11040 N KENDALL DR
Practice Address - Street 2:SUITE# C-100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1272
Practice Address - Country:US
Practice Address - Phone:305-596-9979
Practice Address - Fax:305-598-0063
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46340174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3532140OtherAETNA
FL208186OtherAVMED
FL0515511500Medicaid
FL07-00458OtherUHC TX
FL0015HILHOtherNHP
FL96906OtherBCBS
FLK5219Medicare ID - Type Unspecified
FL0515511500Medicaid