Healthcare Provider Details

I. General information

NPI: 1366142861
Provider Name (Legal Business Name): JOHN EDUARDO CANAS RODRIGUEZ RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15550 SW 80TH ST APT E203
MIAMI FL
33193-3374
US

IV. Provider business mailing address

15550 SW 80TH ST APT E203
MIAMI FL
33193-3374
US

V. Phone/Fax

Practice location:
  • Phone: 786-782-8556
  • Fax:
Mailing address:
  • Phone: 786-782-8556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number21-518
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN9619141
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: