Provider Demographics
NPI:1336342187
Name:CANOVA-DIAZ, CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:CANOVA-DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 BILTMORE WAY STE 200B
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5788
Mailing Address - Country:US
Mailing Address - Phone:305-445-5515
Mailing Address - Fax:305-445-5518
Practice Address - Street 1:470 BILTMORE WAY STE 200B
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5788
Practice Address - Country:US
Practice Address - Phone:305-445-5515
Practice Address - Fax:305-445-5518
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104666207R00000X
PR26315207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty