Provider Demographics
NPI:1669262788
Name:CANALES, JASLYN MONIQUE
Entity type:Individual
Prefix:
First Name:JASLYN
Middle Name:MONIQUE
Last Name:CANALES
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7478 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-5353
Mailing Address - Country:US
Mailing Address - Phone:951-712-7497
Mailing Address - Fax:
Practice Address - Street 1:6649 AMETHYST AVE UNIT 9321
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-1557
Practice Address - Country:US
Practice Address - Phone:909-579-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician