Provider Demographics
NPI:1639832322
Name:CANALES, DANIEL ALEJANDRO (NP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALEJANDRO
Last Name:CANALES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 CROCKETT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-3524
Mailing Address - Country:US
Mailing Address - Phone:323-378-7869
Mailing Address - Fax:
Practice Address - Street 1:1900 W SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-1129
Practice Address - Country:US
Practice Address - Phone:323-377-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2024-08-26
Deactivation Date:2024-06-12
Deactivation Code:
Reactivation Date:2024-07-08
Provider Licenses
StateLicense IDTaxonomies
CA95257800163W00000X
CA95030411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse