Healthcare Provider Details

I. General information

NPI: 1366602146
Provider Name (Legal Business Name): ROSEMARY JANE CANALES CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2008
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 JOHN MUIR PKWY SUITE 105
BRENTWOOD CA
94513-5183
US

IV. Provider business mailing address

3345 MICHELSON DR STE 100
IRVINE CA
92612-0693
US

V. Phone/Fax

Practice location:
  • Phone: 925-513-6533
  • Fax: 925-513-4957
Mailing address:
  • Phone: 888-227-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.10058-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP01610
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: