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Jose Manuel Gonzalez-Canal

Specialist

Other Service Providers

3390 Tamiami Trail, Suite 104, Port Charlotte, FL 33952

PECOS Enrollment

This provider is enrolled in PECOS as JOSE GONZALEZ-CANA.

Based on the most recent information from CMS, provider Jose Manuel Gonzalez-Canal is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:30 PM.

Profile Details

Provider ID
1285606558
Provider Type
Individual
Full Name
Gonzalez-Canal, Jose Manuel
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
2/2/2006
Last Updated
4/18/2017

Contact Information

Practice Location

3390 Tamiami Trail, Suite 104, Port Charlotte, FL 33952

(941) 764-0444

(941) 764-0774

Mailing Location

P.O. Box 510276, Punta Gorda, FL 33951-0276

(941) 764-0444

(941) 764-0774

Provider Taxonomies

Code	Description	License
Code 174400000X Primary	Description Specialist Other Service Providers	License ME0068859 Florida

Provider Identifiers

ID	Description	Issuer
ID 252817700	Description Medicaid	Issuer Unlisted Florida

Jose Manuel Gonzalez-Canal

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

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Description

License

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License

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