MEDICARE: CANO HEALTH NEW MEXICO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1316511520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANO HEALTH NEW MEXICO, LLC

Provider Business Mailing Address
First Line	:	9725 NW 117TH AVE STE 200
Second Line	:
City	:	MEDLEY
State	:	FL
Zip	:	33178-1260
Country	:	US
Telephone Number	:	954-432-0578
Fax Number	:

Provider Business Practice Location Address
First Line	:	2839 CARLISLE BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-2876
Country	:	US
Telephone Number	:	855-226-6633
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MARLOW B HERNANDEZ
Credential	:	MD
Telephone Number	:	954-514-9360

Provider Enumeration Date	:	05/13/2021
Last Update Date	:	05/13/2021

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