Provider Demographics
NPI:1700506813
Name:CASANOVA, HERIBERTO JR
Entity type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:CASANOVA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SAN FRANCISCO
Mailing Address - Street 2:CALLE VIOLETA 232
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:305-528-0185
Mailing Address - Fax:
Practice Address - Street 1:DR. JOSE CELSO BARBOSA DRIVE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-763-1824
Practice Address - Fax:787-756-7944
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program