Provider Demographics
NPI:1356012678
Name:JOHN CANLAS NUTRITION LLC
Entity Type:Organization
Organization Name:JOHN CANLAS NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CANLAS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED DIETITIAN
Authorized Official - Phone:909-362-9434
Mailing Address - Street 1:1647 WILLOW PASS RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2611
Mailing Address - Country:US
Mailing Address - Phone:909-362-9434
Mailing Address - Fax:
Practice Address - Street 1:2075 DIAMOND BLVD STE H-210
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5827
Practice Address - Country:US
Practice Address - Phone:909-362-9434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-26
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty