Healthcare Provider Details

I. General information

NPI: 1912621855
Provider Name (Legal Business Name): KEILA CANETE MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E WYOMING AVE.
PHILADELPHIA PA
19120-1912
US

IV. Provider business mailing address

200 E. WYOMING AVE.
PHILADELPHIA PA
19120
US

V. Phone/Fax

Practice location:
  • Phone: 215-220-4421
  • Fax:
Mailing address:
  • Phone: 215-220-4421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: