MEDICARE: CANO HEALTH NEVADA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1477219764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANO HEALTH NEVADA PLLC

Provider Business Mailing Address
First Line	:	9725 NW 117TH AVE STE 200
Second Line	:
City	:	MEDLEY
State	:	FL
Zip	:	33178-1260
Country	:	US
Telephone Number	:	855-226-6633
Fax Number	:

Provider Business Practice Location Address
First Line	:	4469 CHARLESTON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102
Country	:	US
Telephone Number	:	855-226-6633
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MARLOW BLAS HERNANDEZ
Credential	:	DO
Telephone Number	:	954-514-9360

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	11/11/2021

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