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General NPI Number Information
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NPI Number | 1104789809
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Entity Type | Individual
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Provider Name | DEXTER CANOY
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Gender | Male
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 11301 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90073-1003
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Country | US
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Telephone | 310-478-3711
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Fax |
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Provider Business Mailing Address
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Address Line | 1636 CHERRY TREE PL
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City | UPLAND
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State | CA
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Zip | 91784-2530
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Country | US
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Telephone | 626-510-3301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC1600X
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Taxonomy Name | Continuing Education/Staff Development Registered Nurse
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License Number | 95292177
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 95292177
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163WX0601X
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Taxonomy Name | Otorhinolaryngology & Head-Neck Registered Nurse
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License Number | 95292177
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95292177
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License Number State | CA
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