Provider Demographics
NPI:1396200762
Name:CANALE, EMILY J
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:CANALE
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 1:5565 GROSSMONT CENTER DRIVE, BLDG 3
Mailing Address - Street 2:SUITE 540
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3024
Mailing Address - Country:US
Mailing Address - Phone:619-460-2700
Mailing Address - Fax:619-460-2702
Practice Address - Street 1:5565 GROSSMONT CENTER DRIVE, BLDG. 3
Practice Address - Street 2:SUITE 540
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3024
Practice Address - Country:US
Practice Address - Phone:619-460-2700
Practice Address - Fax:619-460-2702
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-09
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF06182373363LF0000X
CA95014742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily