Provider Demographics
NPI:1063639458
Name:CANABAL PEREZ, CLAUDIA ELVIRA (HYG)
Entity Type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:ELVIRA
Last Name:CANABAL PEREZ
Suffix:
Gender:F
Credentials:HYG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10760 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6462
Mailing Address - Country:US
Mailing Address - Phone:954-370-9188
Mailing Address - Fax:
Practice Address - Street 1:10108 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6963
Practice Address - Country:US
Practice Address - Phone:954-741-0710
Practice Address - Fax:954-742-8489
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH15373124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDH15373OtherHYG LICENCE