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General NPI Number Information
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NPI Number | 1841606100
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Entity Type | Organization
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Legal Business Name | HUMBERTO CASANOVA MD PA
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Dates
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Enumeration Date | 07/08/2014
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 17670 NW 78TH AVE SUITE 109
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City | HIALEAH
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State | FL
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Zip | 33015-3664
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Country | US
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Telephone | 305-827-3388
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Fax | 305-827-4008
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Provider Business Mailing Address
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Address Line | 17670 NW 78TH AVE SUITE 109
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City | HIALEAH
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State | FL
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Zip | 33015-3664
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Country | US
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Telephone | 305-827-3388
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Fax | 305-827-4008
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Authorized Official
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Title or Position | MD
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Name | DR. HUMBERTO CASANOVA
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Credential | MD
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Telephone | 305-827-3388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME83737
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License Number State | FL
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