Healthcare Provider Details

I. General information

NPI: 1689876344
Provider Name (Legal Business Name): MARIANGELA CANAAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIANGELA PENA GONZALEZ MD

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 N LAKEMONT AVE STE B
WINTER PARK FL
32792-3203
US

IV. Provider business mailing address

185 N LAKEMONT AVE STE B
WINTER PARK FL
32792-3203
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-4590
  • Fax:
Mailing address:
  • Phone: 305-595-4590
  • Fax: 305-279-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME 103159
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: