Basic Information
| Provider Information | |||||||||
| NPI: | 1609175553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CANO | ||||||||
| FirstName: | EFREN | ||||||||
| MiddleName: | RICARDO | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1739 E BEVERLY AVE | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | KINGMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864093593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282634547 | ||||||||
| FaxNumber: | 9282634794 | ||||||||
| Practice Location | |||||||||
| Address1: | 2226 HUALAPAI MOUNTAIN RD | ||||||||
| Address2: | |||||||||
| City: | KINGMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864018374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286818703 | ||||||||
| FaxNumber: | 9286818714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2011 | ||||||||
| LastUpdateDate: | 07/17/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 006054 | AZ | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.