Provider Demographics
NPI:1790965523
Name:DAVID CANZONE LLC
Entity Type:Organization
Organization Name:DAVID CANZONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CANZONE
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-989-7418
Mailing Address - Street 1:2074 GALISTEO ST
Mailing Address - Street 2:UNIT A2
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2138
Mailing Address - Country:US
Mailing Address - Phone:505-989-7418
Mailing Address - Fax:505-986-8874
Practice Address - Street 1:2074 GALISTEO ST
Practice Address - Street 2:UNIT A2
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2138
Practice Address - Country:US
Practice Address - Phone:505-989-7418
Practice Address - Fax:505-986-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM195RX1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty