Provider Demographics
NPI:1669528030
Name:ROBERTO A CANO, M.D., P.A.
Entity type:Organization
Organization Name:ROBERTO A CANO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-983-6307
Mailing Address - Street 1:3700 WASHINGTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8256
Mailing Address - Country:US
Mailing Address - Phone:954-983-6307
Mailing Address - Fax:954-983-5809
Practice Address - Street 1:3700 WASHINGTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8256
Practice Address - Country:US
Practice Address - Phone:954-983-6307
Practice Address - Fax:954-983-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374859600Medicaid
FLD58277Medicare UPIN
FL374859600Medicaid