Provider Demographics
NPI:1851460695
Name:CANALS, DESI (MD)
Entity Type:Individual
Prefix:MR
First Name:DESI
Middle Name:
Last Name:CANALS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 E GRIFFIN PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2409
Mailing Address - Country:US
Mailing Address - Phone:956-584-0100
Mailing Address - Fax:956-584-2783
Practice Address - Street 1:1112 E GRIFFIN PKWY STE A
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2409
Practice Address - Country:US
Practice Address - Phone:956-584-0100
Practice Address - Fax:956-584-2783
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145233602Medicaid
TX145233602Medicaid
H45286Medicare UPIN