Provider Demographics
NPI:1194983296
Name:EFREN CASANOVA MD, PC
Entity type:Organization
Organization Name:EFREN CASANOVA MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-347-6620
Mailing Address - Street 1:8711 E PINNACLE PEAK RD
Mailing Address - Street 2:PMB #203
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3517
Mailing Address - Country:US
Mailing Address - Phone:602-347-6620
Mailing Address - Fax:602-569-8308
Practice Address - Street 1:8711 E PINNACLE PEAK RD
Practice Address - Street 2:PMB #203
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3517
Practice Address - Country:US
Practice Address - Phone:602-347-6620
Practice Address - Fax:602-569-8308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29488174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ729262Medicaid