Healthcare Provider Details

I. General information

NPI: 1184152100
Provider Name (Legal Business Name): CANAAN ARCENEAUX DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2017
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6043 HOLLYWOOD BLVD
HOLLYWOOD CA
90028-5411
US

IV. Provider business mailing address

6043 HOLLYWOOD BLVD
HOLLYWOOD CA
90028-5411
US

V. Phone/Fax

Practice location:
  • Phone: 323-653-1990
  • Fax:
Mailing address:
  • Phone: 323-653-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21323
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS020831
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number333562
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: