Provider Demographics
NPI:1518943984
Name:CANONIZADO, LEO M (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:M
Last Name:CANONIZADO
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2520 CHERRY AVE
Mailing Address - Street 2:HARRISON MEDICAL CENTER
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310
Mailing Address - Country:US
Mailing Address - Phone:360-792-6610
Mailing Address - Fax:360-744-6188
Practice Address - Street 1:450 SO. KITSAP BLVD.
Practice Address - Street 2:SUITE 100
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366
Practice Address - Country:US
Practice Address - Phone:360-744-6275
Practice Address - Fax:360-744-6188
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2009-03-24
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical