Provider Demographics
NPI:1093827255
Name:CANALES, ROBERTO (M,D)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:CANALES
Suffix:
Gender:M
Credentials:M,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 CURIE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2910
Mailing Address - Country:US
Mailing Address - Phone:915-532-2985
Mailing Address - Fax:915-542-4927
Practice Address - Street 1:1733 CURIE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2910
Practice Address - Country:US
Practice Address - Phone:915-532-2985
Practice Address - Fax:915-542-4927
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF73492080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87920FMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE
TXB21660Medicare UPIN