Provider Demographics
NPI:1124575055
Name:CANNON, ROYALE
Entity Type:Individual
Prefix:
First Name:ROYALE
Middle Name:
Last Name:CANNON
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 1:3670 N RANCHO DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3174
Mailing Address - Country:US
Mailing Address - Phone:702-432-6463
Mailing Address - Fax:702-432-6464
Practice Address - Street 1:3670 N RANCHO DR
Practice Address - Street 2:SUITE 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3174
Practice Address - Country:US
Practice Address - Phone:702-432-6463
Practice Address - Fax:702-432-6464
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor