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General NPI Number Information
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NPI Number | 1962915868
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Entity Type | Individual
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Provider Name | JOSE LUIS CANCIO
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Gender | Male
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 3611 SW 107TH AVE
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City | MIAMI
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State | FL
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Zip | 33165-3636
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Country | US
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Telephone | 305-223-2618
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Fax |
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Provider Business Mailing Address
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Address Line | 8811 SW 132ND PL
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City | MIAMI
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State | FL
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Zip | 33186-1792
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Country | US
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Telephone | 786-316-8537
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | FL
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