Basic Information
| Provider Information | |||||||||
| NPI: | 1457552945 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CANAVARAS | ||||||||
| FirstName: | ANITA | ||||||||
| MiddleName: | PAULETTE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 350 | ||||||||
| Address2: | |||||||||
| City: | LAKE HUGHES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935320350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617241280 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3005 E PALMDALE BLVD | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935501831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6615750009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | 293534 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 293534 | 01 | CA | RN LICENSE | OTHER | 3680 | 01 | CA | NP CERTIFICATE | OTHER |