=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790960771
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOEL H. CANGA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2008
-----------------------------------------------------
Last Update Date | 02/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001B PITTSBURG ANTIOCH HWY
-----------------------------------------------------
City | PITTSBURG
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94565-4199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-439-6169
-----------------------------------------------------
Fax | 925-439-6387
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5080 SPECTRUM DR SUITE 1200 WEST
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75001-4648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-232-3550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083X0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Physician
-----------------------------------------------------
License Number | A51328
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------