Healthcare Provider Details

I. General information

NPI: 1174442164
Provider Name (Legal Business Name): MERIAN CANELO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 MONUMENT BLVD STE F
PLEASANT HILL CA
94523-3972
US

IV. Provider business mailing address

7985 NW 114TH PATH
DORAL FL
33178-2509
US

V. Phone/Fax

Practice location:
  • Phone: 925-363-4455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: