Healthcare Provider Details

I. General information

NPI: 1770194243
Provider Name (Legal Business Name): ALEJANDRO A DACANAY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEX A DACANAY FNP

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 S DOBSON RD STE 106
MESA AZ
85202-4769
US

IV. Provider business mailing address

PO BOX 6423
CHANDLER AZ
85246-6423
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-3637
  • Fax: 480-969-6568
Mailing address:
  • Phone: 480-855-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN221834
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: