Healthcare Provider Details

I. General information

NPI: 1912753799
Provider Name (Legal Business Name): JENNIFER CANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18646 OXNARD ST
TARZANA CA
91356-1411
US

IV. Provider business mailing address

12003 RIALTO ST
SUN VALLEY CA
91352-3042
US

V. Phone/Fax

Practice location:
  • Phone: 818-654-3908
  • Fax:
Mailing address:
  • Phone: 818-754-7803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: