Healthcare Provider Details

I. General information

NPI: 1801356548
Provider Name (Legal Business Name): MARILIAN A. CANALS RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 SUN CITY CENTER PLZ STE 104
SUN CITY CENTER FL
33573-5334
US

IV. Provider business mailing address

8333 NW 53RD ST FL 6
DORAL FL
33166-4783
US

V. Phone/Fax

Practice location:
  • Phone: 813-278-7796
  • Fax: 813-379-2479
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME152936
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: