Provider Demographics
NPI:1902443609
Name:CANO PCP WOUND CARE, LLC
Entity Type:Organization
Organization Name:CANO PCP WOUND CARE, LLC
Other - Org Name:WOUND HEALING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLOW
Authorized Official - Middle Name:B
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-514-9360
Mailing Address - Street 1:9725 NW 117TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1260
Mailing Address - Country:US
Mailing Address - Phone:954-514-9360
Mailing Address - Fax:
Practice Address - Street 1:9725 NW 117TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33178-1260
Practice Address - Country:US
Practice Address - Phone:954-514-9360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty