Provider Demographics
NPI:1861682395
Name:CANALES, TRICIA SUE
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:SUE
Last Name:CANALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 E ARCHER RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-9245
Mailing Address - Country:US
Mailing Address - Phone:281-839-0226
Mailing Address - Fax:
Practice Address - Street 1:2706 E ARCHER RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-9245
Practice Address - Country:US
Practice Address - Phone:281-839-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor