Healthcare Provider Details

I. General information

NPI: 1881382174
Provider Name (Legal Business Name): DAVID KEITH CANETE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 NEVADA AVE
EL MONTE CA
91733-2318
US

IV. Provider business mailing address

1701 E D ST APT 813
ONTARIO CA
91764-5604
US

V. Phone/Fax

Practice location:
  • Phone: 626-443-9425
  • Fax:
Mailing address:
  • Phone: 909-488-6029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95024960
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95024960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: