Provider Demographics
NPI:1700022894
Name:CANLAS, SHELLEY SANTOS (MD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:SANTOS
Last Name:CANLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:SANTOS CANLAS
Other - Last Name:BENEDICT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2212 E 4TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3871
Mailing Address - Country:US
Mailing Address - Phone:714-571-7700
Mailing Address - Fax:714-571-7702
Practice Address - Street 1:2212 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3870
Practice Address - Country:US
Practice Address - Phone:714-571-7700
Practice Address - Fax:714-571-7702
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106335207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine