Healthcare Provider Details

I. General information

NPI: 1043903370
Provider Name (Legal Business Name): RAUL VALDES CANOVA SR. SURGICAL ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5327 NW 30TH PL
MIAMI FL
33142-3405
US

IV. Provider business mailing address

5327 NW 30TH PL
MIAMI FL
33142-3405
US

V. Phone/Fax

Practice location:
  • Phone: 786-665-5985
  • Fax:
Mailing address:
  • Phone: 786-665-5985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number025220
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number21-344
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: