Healthcare Provider Details

I. General information

NPI: 1639832322
Provider Name (Legal Business Name): DANIEL ALEJANDRO CANALES NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date: 06/12/2024
Reactivation Date: 07/08/2024

III. Provider practice location address

1900 W SLAUSON AVE
LOS ANGELES CA
90047-1129
US

IV. Provider business mailing address

8105 CROCKETT BLVD
LOS ANGELES CA
90001-3524
US

V. Phone/Fax

Practice location:
  • Phone: 323-377-7678
  • Fax:
Mailing address:
  • Phone: 323-378-7869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030411
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95257800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: