Healthcare Provider Details

I. General information

NPI: 1417102583
Provider Name (Legal Business Name): MARCOS S CANAS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 WHITTIER BLVD
LOS ANGELES CA
90023-2526
US

IV. Provider business mailing address

PO BOX 3098
TORRANCE CA
90510-3098
US

V. Phone/Fax

Practice location:
  • Phone: 310-792-3914
  • Fax: 310-792-3621
Mailing address:
  • Phone: 310-792-3914
  • Fax: 310-792-3621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA30900
License Number StateCA

VIII. Authorized Official

Name: DR. MARCOS S CANAS
Title or Position: PRESIDENT
Credential: MD
Phone: 310-792-3914