| Jose M Gonzalez-canal P A | |
|
3390 Tamiami Trail, Suite 104 Port Charlotte FL 33952-8161 | |
| (941) 764-0444 | |
| (941) 764-0774 |
| Full Name | Jose M Gonzalez-canal P A |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3390 Tamiami Trail, Suite 104, Port Charlotte, Florida |
| Authorized Official Name and Position | Jose M Gonzalez-canal (PRESIDENT) |
| Authorized Official Contact | 9417640444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jose M Gonzalez-canal P A Po Box 510276 Punta Gorda FL 33951-0276 Ph: (941) 764-0444 | Jose M Gonzalez-canal P A 3390 Tamiami Trail, Suite 104 Port Charlotte FL 33952-8161 Ph: (941) 764-0444 |
| NPI Number | 1568514073 |
|---|---|
| Provider Enumeration Date | 01/17/2007 |
| Last Update Date | 06/26/2008 |
| Medicare PECOS PAC ID | 4981781440 |
|---|---|
| Medicare Enrollment ID | O20080709000435 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568514073 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ME0068859 (Florida) | Primary |
| Provider Name | Jose M Gonzalez-cana |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285606558 PECOS PAC ID: 7315939246 Enrollment ID: I20040331001597 |
| Provider Name | Chantelle M Grant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780855312 PECOS PAC ID: 1759454747 Enrollment ID: I20080724000274 |
| Provider Name | Cohleen M Nottingham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619293180 PECOS PAC ID: 4082746318 Enrollment ID: I20100721000694 |
| Provider Name | Colleen N Hosp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962826024 PECOS PAC ID: 3577866433 Enrollment ID: I20160127000247 |
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