Healthcare Provider Details

I. General information

NPI: 1124965587
Provider Name (Legal Business Name): ISAAC JAVIER CANALES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 VINE ST STE 100
RIVERSIDE CA
92507-4126
US

IV. Provider business mailing address

100 ABERDEEN DR
RIVERSIDE CA
92507-4661
US

V. Phone/Fax

Practice location:
  • Phone: 951-363-0200
  • Fax:
Mailing address:
  • Phone: 323-482-2475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: