Provider Demographics
NPI:1558362905
Name:CANLAS, MARIA CECILIA S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA CECILIA
Middle Name:S
Last Name:CANLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:23517 MAIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5251
Mailing Address - Country:US
Mailing Address - Phone:310-518-6246
Mailing Address - Fax:310-518-6247
Practice Address - Street 1:23517 MAIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-5251
Practice Address - Country:US
Practice Address - Phone:310-518-6246
Practice Address - Fax:310-518-6247
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200301210207R00000X
CAA90534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7308694OtherAETNA ID
CA7308694OtherAETNA ID
CAWA90534AMedicare ID - Type UnspecifiedMEDICARE ID