Provider Demographics
NPI:1346766318
Name:CANAL, EDWIN W
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:W
Last Name:CANAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 71ST ST APT#8
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-5360
Mailing Address - Country:US
Mailing Address - Phone:786-314-4590
Mailing Address - Fax:
Practice Address - Street 1:1208 71ST ST APT 8
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3649
Practice Address - Country:US
Practice Address - Phone:786-314-4590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician