Provider Demographics
NPI:1023237518
Name:ROBERTO CANALES M.D. P.A.
Entity type:Organization
Organization Name:ROBERTO CANALES M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-532-2985
Mailing Address - Street 1:1733 CURIE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2910
Mailing Address - Country:US
Mailing Address - Phone:915-401-7306
Mailing Address - Fax:915-577-9315
Practice Address - Street 1:1733 CURIE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2910
Practice Address - Country:US
Practice Address - Phone:915-532-2985
Practice Address - Fax:915-577-9315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7349174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141624001Medicaid
TX141624001Medicaid