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1487792461 NPI number — WILFREDO CANALES

NPI Number: 1487792461
Health Care Provider/Practitioner: WILFREDO CANALES

Information about “1487792461” NPI (WILFREDO CANALES) exists in 1487792461 in HTML format HTML  |  1487792461 in plain Text format TXT  |  1487792461 in PDF (Portable Document Format) PDF  |  1487792461 in an XML format XML  formats.

NPI Number : 1487792461 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1487792461",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CANALES",
    "FirstName": "WILFREDO",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1301 NE MIAMI GARDENS DR APT 1525",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIAMI GARDENS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33179-4994",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "305-333-0879",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1414 NW 107TH AVE STE 101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SWEETWATER",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33172-2739",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "305-640-8675",
    "PracticeLocationAddressFaxNumber": "305-414-2990",
    "EnumerationDate": "02/02/2007",
    "LastUpdateDate": "07/30/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "PT17474",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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