Provider Demographics
NPI:1710597471
Name:CANALES, CIOMARA MARLENY
Entity Type:Individual
Prefix:MRS
First Name:CIOMARA
Middle Name:MARLENY
Last Name:CANALES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CIOMARA
Other - Middle Name:MARLENY
Other - Last Name:CANALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25835 BASIL CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5025
Mailing Address - Country:US
Mailing Address - Phone:818-602-7195
Mailing Address - Fax:
Practice Address - Street 1:25835 BASIL CT
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5025
Practice Address - Country:US
Practice Address - Phone:818-602-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Single Specialty