Provider Demographics
NPI:1154930469
Name:CANNA-CARE HEALTH
Entity type:Organization
Organization Name:CANNA-CARE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALTAGRACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-305-0310
Mailing Address - Street 1:1000 5TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6510
Mailing Address - Country:US
Mailing Address - Phone:305-305-0310
Mailing Address - Fax:
Practice Address - Street 1:1000 5TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6510
Practice Address - Country:US
Practice Address - Phone:305-305-0310
Practice Address - Fax:888-419-8506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REJUVENATE MED SPA PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care