MEDICARE: DONNA NATIVIDAD CANLAS MD

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	207Q00000X	Family Medicine Physician	K3119	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	10030907	OTHER	TX	AMERIGROUP
4	0049KA	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1205026242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA NATIVIDAD CANLAS MD

Provider Business Mailing Address
First Line	:	4615 SOUTHWEST FWY
Second Line	:	SUITE 850
City	:	HOUSTON
State	:	TX
Zip	:	77027-7162
Country	:	US
Telephone Number	:	713-291-3426
Fax Number	:	832-767-2314

Provider Business Practice Location Address
First Line	:	4615 SOUTHWEST FWY
Second Line	:	SUITE 850
City	:	HOUSTON
State	:	TX
Zip	:	77027-7162
Country	:	US
Telephone Number	:	713-291-3426
Fax Number	:	832-767-2314

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	11/25/2019

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