Healthcare Provider Details

I. General information

NPI: 1821426388
Provider Name (Legal Business Name): YVETTE CANABA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 MISSION GORGE RD STE K1
SANTEE CA
92071-3026
US

IV. Provider business mailing address

10201 MISSION GORGE RD STE K1
SANTEE CA
92071-3026
US

V. Phone/Fax

Practice location:
  • Phone: 619-449-9100
  • Fax: 619-449-0722
Mailing address:
  • Phone: 619-449-9100
  • Fax: 619-449-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number65-P89997
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number59.000634
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE5496
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5496
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE5496
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE5496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: