Provider Demographics
NPI:1811239197
Name:CANEDO, MONICA (ANP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:CANEDO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 DATAPOINT DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3298
Mailing Address - Country:US
Mailing Address - Phone:210-614-1234
Mailing Address - Fax:210-614-0952
Practice Address - Street 1:5223 HAMILTON WOLFE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4463
Practice Address - Country:US
Practice Address - Phone:210-614-1234
Practice Address - Fax:210-614-0952
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX703868363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX294751YKXJMedicare Oscar/Certification