Provider Demographics
NPI:1558924142
Name:CANLAS, ELENA BALTAZAR
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:BALTAZAR
Last Name:CANLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 MARGARET CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-2043
Mailing Address - Country:US
Mailing Address - Phone:907-250-9404
Mailing Address - Fax:907-868-1156
Practice Address - Street 1:1311 W 40TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6507
Practice Address - Country:US
Practice Address - Phone:907-250-9404
Practice Address - Fax:907-868-1156
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNUAA4861376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide