Provider Demographics
NPI:1093466849
Name:CANAL MORENO, DANITZA LORENA (SA-C)
Entity Type:Individual
Prefix:
First Name:DANITZA
Middle Name:LORENA
Last Name:CANAL MORENO
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14313 AVALON RESERVE BLVD APT 304
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-5139
Mailing Address - Country:US
Mailing Address - Phone:786-508-3865
Mailing Address - Fax:
Practice Address - Street 1:14313 AVALON RESERVE BLVD APT 304
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-5139
Practice Address - Country:US
Practice Address - Phone:786-508-3865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21-178246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant