Provider Demographics
NPI:1073141610
Name:CANELA, IRMA ELISA
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:ELISA
Last Name:CANELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 BEGONIA DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5492
Mailing Address - Country:US
Mailing Address - Phone:925-732-8161
Mailing Address - Fax:
Practice Address - Street 1:792 BEGONIA DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5492
Practice Address - Country:US
Practice Address - Phone:925-732-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician