Provider Demographics
NPI:1558024570
Name:CANONIZADO, EUNICE JILL MALLARE (MSN, FNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:EUNICE JILL
Middle Name:MALLARE
Last Name:CANONIZADO
Suffix:
Gender:F
Credentials:MSN, FNP-BC, FNP-C
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Mailing Address - Street 1:1818 S STATE COLLEGE BLVD UNIT 248
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-8908
Mailing Address - Country:US
Mailing Address - Phone:619-208-6882
Mailing Address - Fax:
Practice Address - Street 1:661 W 1ST ST STE G
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2939
Practice Address - Country:US
Practice Address - Phone:714-665-9890
Practice Address - Fax:714-665-9891
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2023-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA95018278363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner