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General NPI Number Information
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NPI Number | 1194920835
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Entity Type | Organization
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Legal Business Name | ROY L CAIVANO
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 714 SW WILSHIRE BLVD
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City | BURLESON
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State | TX
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Zip | 76028-5711
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Country | US
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Telephone | 817-447-9900
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Fax | 817-447-5010
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Provider Business Mailing Address
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Address Line | 714 SW WILSHIRE BLVD
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City | BURLESON
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State | TX
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Zip | 76028-5711
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Country | US
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Telephone | 817-447-9900
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Fax | 817-447-5010
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Authorized Official
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Title or Position | OWNER
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Name | ROY L CAIVANO
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Credential | D.O
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Telephone | 817-447-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | M1052
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J7923
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License Number State | TX
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