1558362905 NPI number — DR. MARIA CECILIA S CANLAS MD

Table of content: DR. MARIA CECILIA S CANLAS MD (NPI 1558362905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558362905 NPI number — DR. MARIA CECILIA S CANLAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANLAS
Provider First Name:
MARIA CECILIA
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558362905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23517 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
CARSON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90745-5251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-518-6246
Provider Business Mailing Address Fax Number:
310-518-6247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23517 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
CARSON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90745-5251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-518-6246
Provider Business Practice Location Address Fax Number:
310-518-6247
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  200301210 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: A90534 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7308694 . This is a "AETNA ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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