Individual
DR. DIEGO MARTIN CAIVANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(904) 346-0113
Mailing address
393 E WALNUT ST, PHR GROUP PROVIDER ENROLLMENT UNIT 3RD FL, PASADENA, CA 91188-0001
(877) 608-0044
(877) 514-0903
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0101241979
VA
207P00000X
Emergency Medicine Physician
234090-1
NY
207P00000X
Emergency Medicine Physician
Primary
C54160
CA
Other
Enumeration date
06/07/2007
Last updated
12/01/2021
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