Healthcare Provider Details

I. General information

NPI: 1902634090
Provider Name (Legal Business Name): NANCY CANALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20723 WALNUT VALLEY DR
WALNUT CA
91789-1024
US

IV. Provider business mailing address

PO BOX 2232
WALNUT CA
91788-2232
US

V. Phone/Fax

Practice location:
  • Phone: 909-595-1177
  • Fax:
Mailing address:
  • Phone: 909-594-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156534
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: