Provider Demographics
NPI:1942775218
Name:CANOVA-PEREZ, MICHEL (CBHCH/BS)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:
Last Name:CANOVA-PEREZ
Suffix:
Gender:M
Credentials:CBHCH/BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10901 NE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7000
Mailing Address - Country:US
Mailing Address - Phone:786-661-0148
Mailing Address - Fax:305-646-0113
Practice Address - Street 1:2780 SW 37TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:COCONUT GROVE
Practice Address - State:FL
Practice Address - Zip Code:33133-2740
Practice Address - Country:US
Practice Address - Phone:305-646-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM102137171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator