Provider Demographics
NPI:1457469280
Name:CANALES, KAIZA C (MRS)
Entity Type:Individual
Prefix:MRS
First Name:KAIZA
Middle Name:C
Last Name:CANALES
Suffix:
Gender:F
Credentials:MRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 KEATON SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-1882
Mailing Address - Country:US
Mailing Address - Phone:787-406-7509
Mailing Address - Fax:787-406-7509
Practice Address - Street 1:17410 SR 50 STE 130
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8188
Practice Address - Country:US
Practice Address - Phone:407-717-1305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2049103T00000X
FLMH21375101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologist