Provider Demographics
NPI:1689388738
Name:CANO GONZALEZ, CLARA ISABEL
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:ISABEL
Last Name:CANO GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 WOODLARK DR
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-7747
Mailing Address - Country:US
Mailing Address - Phone:407-592-6594
Mailing Address - Fax:
Practice Address - Street 1:1091 WOODLARK DR
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-7747
Practice Address - Country:US
Practice Address - Phone:407-592-6594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA98278225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist