Provider Demographics
NPI:1851789192
Name:CHANOINE, ANNA JOSE ELISSENDA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:JOSE ELISSENDA
Last Name:CHANOINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 E SAMPLE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-4432
Mailing Address - Country:US
Mailing Address - Phone:754-205-2491
Mailing Address - Fax:754-205-5156
Practice Address - Street 1:440 E SAMPLE RD STE 107
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-4432
Practice Address - Country:US
Practice Address - Phone:754-205-2491
Practice Address - Fax:754-205-5156
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18967208D00000X
FLACN828208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice