Provider Demographics
NPI:1205026242
Name:CANLAS, DONNA NATIVIDAD (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:NATIVIDAD
Last Name:CANLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:A
Other - Last Name:NATIVIDAD-DUREMDES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4615 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7162
Mailing Address - Country:US
Mailing Address - Phone:713-291-3426
Mailing Address - Fax:832-767-2314
Practice Address - Street 1:4615 SOUTHWEST FWY
Practice Address - Street 2:SUITE 850
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7162
Practice Address - Country:US
Practice Address - Phone:713-291-3426
Practice Address - Fax:832-767-2314
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124504508Medicaid
TX124504507Medicaid
TX10030907OtherAMERIGROUP
TX0049KAOtherBLUE CROSS BLUE SHIELD
TX10030907OtherAMERIGROUP