Healthcare Provider Details

I. General information

NPI: 1962060475
Provider Name (Legal Business Name): ADRIANA GONZALEZ-CANAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10141 BIG BEND RD STE 101
RIVERVIEW FL
33578-7419
US

IV. Provider business mailing address

2995 DREW ST
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-397-1270
  • Fax: 813-397-1271
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME157382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: