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General NPI Number Information
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NPI Number | 1245263730
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Entity Type | Individual
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Provider Name | TATIANA CANNING
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Gender | Female
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 3917 WEST RD
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City | LOS ALAMOS
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State | NM
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Zip | 87544-2275
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Country | US
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Telephone | 505-753-1866
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 129
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City | LOS ALAMOS
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State | NM
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Zip | 87544-0129
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Country | US
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Telephone |
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 20040710
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License Number State | NM
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