Healthcare Provider Details

I. General information

NPI: 1972799591
Provider Name (Legal Business Name): CAMILLE NANETTE CASASNOVAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AMERICO MIRANDA AVE. PEDIATRIC UNIVERSITY DISTRICT HOSPITAL
SAN JUAN PR
00927
US

IV. Provider business mailing address

COND JARD METRO II APT 2M
SAN JUAN PR
00927
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3535
  • Fax:
Mailing address:
  • Phone: 787-763-1196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17978
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: