Provider Demographics
NPI:1609175553
Name:CANO, EFREN RICARDO (DO)
Entity Type:Individual
Prefix:
First Name:EFREN
Middle Name:RICARDO
Last Name:CANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 E BEVERLY AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3593
Mailing Address - Country:US
Mailing Address - Phone:928-263-4547
Mailing Address - Fax:928-263-4794
Practice Address - Street 1:2226 HUALAPAI MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-8374
Practice Address - Country:US
Practice Address - Phone:928-681-8703
Practice Address - Fax:928-681-8714
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006054208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice