Healthcare Provider Details

I. General information

NPI: 1043970106
Provider Name (Legal Business Name): SABRINA CANOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 E 27TH ST
OAKLAND CA
94601-1912
US

IV. Provider business mailing address

9363 BENBOW DR
GILROY CA
95020-8118
US

V. Phone/Fax

Practice location:
  • Phone: 510-535-5115
  • Fax: 510-535-5222
Mailing address:
  • Phone: 951-514-8997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95244921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: