Provider Demographics
NPI:1619993698
Name:CANO, LUZ ELENA (MD)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:ELENA
Last Name:CANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-5932
Mailing Address - Country:US
Mailing Address - Phone:949-645-5933
Mailing Address - Fax:949-645-4658
Practice Address - Street 1:359 SAN MIGUEL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7812
Practice Address - Country:US
Practice Address - Phone:949-645-5933
Practice Address - Fax:949-645-4658
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054444207R00000X
CAA054442084N0400X
CAA54444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A544441Medicaid
CA00A544441Medicaid
G22127Medicare UPIN
CAG22127Medicare UPIN