Provider Demographics
NPI:1548613623
Name:CANELLOS, DENISE (MS, CNS)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:CANELLOS
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 BARRANCA PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4710
Mailing Address - Country:US
Mailing Address - Phone:949-681-8261
Mailing Address - Fax:
Practice Address - Street 1:4000 BARRANCA PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4710
Practice Address - Country:US
Practice Address - Phone:949-681-8261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education