Provider Demographics
NPI:1780748624
Name:CAIVANO, RESA RENAY (MD)
Entity type:Individual
Prefix:DR
First Name:RESA
Middle Name:RENAY
Last Name:CAIVANO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:837 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2628
Mailing Address - Country:US
Mailing Address - Phone:626-398-6300
Mailing Address - Fax:626-204-0086
Practice Address - Street 1:1855 N FAIR OAKS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1620
Practice Address - Country:US
Practice Address - Phone:626-398-6300
Practice Address - Fax:626-204-0086
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2021-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC54520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871689315Medicaid