Healthcare Provider Details

I. General information

NPI: 1225868623
Provider Name (Legal Business Name): CANYBEC SULAYMAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29000 S WESTERN AVE STE 205
RANCHO PALOS VERDES CA
90275-0890
US

IV. Provider business mailing address

29000 S WESTERN AVE STE 205
RANCHO PALOS VERDES CA
90275-0890
US

V. Phone/Fax

Practice location:
  • Phone: 310-955-1041
  • Fax:
Mailing address:
  • Phone: 310-955-1041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95031206
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number323197
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number95031206
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberNP95031206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: