Provider Demographics
NPI:1780919514
Name:CASANOVA, CAMILO FEDERICO (MD)
Entity type:Individual
Prefix:DR
First Name:CAMILO
Middle Name:FEDERICO
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 1:301 174TH ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3206
Mailing Address - Country:US
Mailing Address - Phone:786-597-1132
Mailing Address - Fax:
Practice Address - Street 1:CALLE INDEPENDENCIA # 136
Practice Address - Street 2:
Practice Address - City:SANTIAGO
Practice Address - State:SANTIAGO
Practice Address - Zip Code:51000
Practice Address - Country:DO
Practice Address - Phone:809-881-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator