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General NPI Number Information
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NPI Number | 1972068914
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Entity Type | Individual
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Provider Name | CARLOS A. CANAN
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Gender | Male
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 2755 E DESERT INN RD STE 260
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City | LAS VEGAS
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State | NV
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Zip | 89121-3690
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Country | US
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Telephone | 702-823-8603
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Fax |
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Provider Business Mailing Address
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Address Line | 3908 AVONWOOD AVE
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City | LAS VEGAS
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State | NV
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Zip | 89121-4506
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Country | US
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Telephone | 702-823-8603
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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