MEDICARE: ERENDIDA CANO FNP

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	363LF0000X	Family Nurse Practitioner	95022143	CA

General Provider Information

NPI Number	:	1265158448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERENDIDA CANO FNP

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 VINE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-2702
Country	:	US
Telephone Number	:	323-461-3106
Fax Number	:

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

Provider Enumeration Date	:	10/18/2022
Last Update Date	:	12/15/2022

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