Provider Demographics
NPI:1457149486
Name:CANOLA, ELVIA AMPARO
Entity type:Individual
Prefix:
First Name:ELVIA
Middle Name:AMPARO
Last Name:CANOLA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7747 JUBILEE PARK BLVD APT 1124
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1317
Mailing Address - Country:US
Mailing Address - Phone:321-353-0538
Mailing Address - Fax:
Practice Address - Street 1:7747 JUBILEE PARK BLVD APT 1124
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1317
Practice Address - Country:US
Practice Address - Phone:213-530-0538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation