Provider Demographics
NPI:1457552945
Name:CANAVARAS, ANITA PAULETTE (NP)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:PAULETTE
Last Name:CANAVARAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:LAKE HUGHES
Mailing Address - State:CA
Mailing Address - Zip Code:93532-0350
Mailing Address - Country:US
Mailing Address - Phone:661-724-1280
Mailing Address - Fax:
Practice Address - Street 1:3005 E PALMDALE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-1831
Practice Address - Country:US
Practice Address - Phone:661-575-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293534363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA293534OtherRN LICENSE
CA3680OtherNP CERTIFICATE