Provider Demographics
NPI:1649564345
Name:CANON GARZON, LUISA FERNANDA
Entity Type:Individual
Prefix:MS
First Name:LUISA
Middle Name:FERNANDA
Last Name:CANON GARZON
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 1:2255 GREEN OAK CT
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5313
Mailing Address - Country:US
Mailing Address - Phone:818-620-3176
Mailing Address - Fax:
Practice Address - Street 1:695 S VERMONT AVE
Practice Address - Street 2:15TH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1349
Practice Address - Country:US
Practice Address - Phone:213-251-6854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program