Provider Demographics
NPI:1285766519
Name:CASANOVA, MICHELE LEE
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LEE
Last Name:CASANOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12517 PACIFIC PL
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1102
Mailing Address - Country:US
Mailing Address - Phone:562-907-9957
Mailing Address - Fax:
Practice Address - Street 1:110 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3810
Practice Address - Country:US
Practice Address - Phone:562-869-9255
Practice Address - Fax:562-869-9241
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator