MEDICARE: KEVIN CANALE MS, CPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1013504869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN CANALE MS, CPT

Provider Business Mailing Address
First Line	:	6329 OSLER ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-5409
Country	:	US
Telephone Number	:	858-776-6370
Fax Number	:

Provider Business Practice Location Address
First Line	:	6329 OSLER ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-5409
Country	:	US
Telephone Number	:	858-776-6370
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2020
Last Update Date	:	12/28/2020

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