=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942428081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUAN R. CANALS MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 LINCOLN RD 375
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33139-2452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-538-5336
-----------------------------------------------------
Fax | 305-672-7969
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 LINCOLN RD 375
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33139-2452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-538-5336
-----------------------------------------------------
Fax | 305-672-7969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | 1
-----------------------------------------------------
Name | JUAN RAMON CANALS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-538-5336
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------