Provider Demographics
NPI:1508216292
Name:CANALES, ROGER J (CSA)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:J
Last Name:CANALES
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1995 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1147
Mailing Address - Country:US
Mailing Address - Phone:954-791-6146
Mailing Address - Fax:954-332-2733
Practice Address - Street 1:1995 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1147
Practice Address - Country:US
Practice Address - Phone:954-791-6146
Practice Address - Fax:954-337-2733
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant