MEDICARE: MR. CHRISTIAN CASANOVA CARRASCO DBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	G083821	FL

General Provider Information

NPI Number	:	1477365351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTIAN CASANOVA CARRASCO DBA

Provider Business Mailing Address
First Line	:	8718 BRACKENWOOD DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32829
Country	:	US
Telephone Number	:	321-389-0730
Fax Number	:

Provider Business Practice Location Address
First Line	:	8718 BRACKENWOOD DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32829
Country	:	US
Telephone Number	:	321-389-0730
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2025
Last Update Date	:	02/11/2025

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