MEDICARE: MS. ISABEL CANEZ RD

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	133V00000X	Registered Dietitian	896485	AZ

General Provider Information

NPI Number	:	1811967052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ISABEL CANEZ RD

Provider Business Mailing Address
First Line	:	3930 S ALMA SCHOOL RD STE 8
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-4510
Country	:	US
Telephone Number	:	480-258-3653
Fax Number	:

Provider Business Practice Location Address
First Line	:	3930 S ALMA SCHOOL RD STE 8
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-4510
Country	:	US
Telephone Number	:	480-258-3653
Fax Number	:

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	01/23/2009

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