Provider Demographics
NPI:1255878542
Name:CANADA, KATE
Entity type:Individual
Prefix:MISS
First Name:KATE
Middle Name:
Last Name:CANADA
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 1:10620 WHIPPLE ST UNIT 301
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2932
Mailing Address - Country:US
Mailing Address - Phone:626-673-0237
Mailing Address - Fax:
Practice Address - Street 1:10620 WHIPPLE ST UNIT 301
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2932
Practice Address - Country:US
Practice Address - Phone:626-673-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372500000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker