Healthcare Provider Details

I. General information

NPI: 1669393385
Provider Name (Legal Business Name): MICHELLE URIAS CANIZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23046 AVENIDA DE LA CARLOTA STE 600
LAGUNA HILLS CA
92653-1537
US

IV. Provider business mailing address

15130 ARROYO DR # 15130
IRVINE CA
92617-5303
US

V. Phone/Fax

Practice location:
  • Phone: 714-805-9070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: