Basic Information
| Provider Information | |||||||||
| NPI: | 1366602146 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANALES | ||||||||
| FirstName: | ROSEMARY | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3345 MICHELSON DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926120693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882273312 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 350 JOHN MUIR PKWY | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945135183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9255136533 | ||||||||
| FaxNumber: | 9255134957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2008 | ||||||||
| LastUpdateDate: | 07/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | COA.10058-NP | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | CNP01610 | NM | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 22958 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.