Healthcare Provider Details

I. General information

NPI: 1093644668
Provider Name (Legal Business Name): CONSULTORIO MEDICO DR CANALES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB CAROLINA ALTA CALLE MILAGROS CABEZAS UNIDAD A #B9
CAROLINA PR
00987-7108
US

IV. Provider business mailing address

PO BOX 8188
CAROLINA PR
00986-8188
US

V. Phone/Fax

Practice location:
  • Phone: 787-230-6230
  • Fax:
Mailing address:
  • Phone: 787-230-6230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ERNIE CANALES RIVERA
Title or Position: OWNER
Credential: MD
Phone: 787-349-3341