Provider Demographics
NPI:1386777225
Name:CASANOVA, DANIEL JR (PA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:CASANOVA
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1710 RENEE LN
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5966
Mailing Address - Country:US
Mailing Address - Phone:956-451-8469
Mailing Address - Fax:
Practice Address - Street 1:701 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-2765
Practice Address - Country:US
Practice Address - Phone:956-464-3649
Practice Address - Fax:956-464-3670
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04945363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant