Provider Demographics
NPI:1124795984
Name:CANO HEALTH OF PUERTO RICO, LLC
Entity type:Organization
Organization Name:CANO HEALTH OF PUERTO RICO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLOW
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-514-9360
Mailing Address - Street 1:9725 NW 117TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1260
Mailing Address - Country:US
Mailing Address - Phone:954-432-0578
Mailing Address - Fax:954-432-5060
Practice Address - Street 1:CALLE BAHUINIA Z-978
Practice Address - Street 2:
Practice Address - City:LOIZA VALLEY CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:855-226-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty