Healthcare Provider Details

I. General information

NPI: 1558557744
Provider Name (Legal Business Name): RICHARD P. CANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

PO BOX 515412
LOS ANGELES CA
90051-6712
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-5438
  • Fax: 949-764-5674
Mailing address:
  • Phone: 949-764-5438
  • Fax: 949-764-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA96705
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number38479
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number38479
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: