Healthcare Provider Details

I. General information

NPI: 1063860351
Provider Name (Legal Business Name): MARTHA GARCIA CANALES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/04/2024
Certification Date: 05/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 N 160TH AVE
GOODYEAR AZ
85395-7601
US

IV. Provider business mailing address

2485 N 160TH AVE
GOODYEAR AZ
85395-7601
US

V. Phone/Fax

Practice location:
  • Phone: 786-527-1392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10271
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: