MEDICARE: ERNESTO CANEZ

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	171W00000X	Contractor	1128333	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1128333	OTHER	AZ	PROFESSIONAL FOSTER CARE

General Provider Information

NPI Number	:	1770731630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNESTO CANEZ

Provider Business Mailing Address
First Line	:	2744 W CALLE MORADO
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2522
Country	:	US
Telephone Number	:	520-721-1887
Fax Number	:

Provider Business Practice Location Address
First Line	:	2744 W CALLE MORADO
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2522
Country	:	US
Telephone Number	:	520-721-1887
Fax Number	:

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

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	09/04/2008

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Directions to “ ERNESTO CANEZ ” Practice Location

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