Provider Demographics
NPI:1497832984
Name:CANUL, GERARDO D (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:D
Last Name:CANUL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9413
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-9413
Mailing Address - Country:US
Mailing Address - Phone:949-468-7272
Mailing Address - Fax:949-679-4446
Practice Address - Street 1:2182 DUPONT DR STE 24
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1360
Practice Address - Country:US
Practice Address - Phone:949-468-7272
Practice Address - Fax:949-679-4446
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19755103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical