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NPI Code Detail

MEDICARE: KARLA MICHELLE CANIZALES

MEDICARE:   KARLA MICHELLE CANIZALES
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1740952662
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARLA MICHELLE CANIZALES
Provider Business Mailing Address
First Line : 1586 MOUNT TAMALPAIS AVE
Second Line :
City : CHULA VISTA
State : CA
Zip : 91913-2928
Country : US
Telephone Number : 951-210-6380
Fax Number :
Provider Business Practice Location Address
First Line : 1586 MOUNT TAMALPAIS AVE
Second Line :
City : CHULA VISTA
State : CA
Zip : 91913-2928
Country : US
Telephone Number : 951-210-6380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2021
Last Update Date : 09/29/2021

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Directions to “ KARLA MICHELLE CANIZALES ” Practice Location

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