Provider Demographics
NPI:1043903370
Name:VALDES CANOVA, RAUL SR (SURGICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:VALDES CANOVA
Suffix:SR
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 S DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6914
Mailing Address - Country:US
Mailing Address - Phone:305-441-6812
Mailing Address - Fax:
Practice Address - Street 1:3581 NW 97TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-2238
Practice Address - Country:US
Practice Address - Phone:786-665-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21-344246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant