Provider Demographics
NPI:1740526102
Name:CANON, ROSALBA PULLIDO
Entity type:Individual
Prefix:
First Name:ROSALBA
Middle Name:PULLIDO
Last Name:CANON
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 1:1752 COLUMBIA RD NW STE 200
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-8837
Mailing Address - Country:US
Mailing Address - Phone:202-808-2362
Mailing Address - Fax:
Practice Address - Street 1:5740 COLORADO AVE NW APT 301
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7830
Practice Address - Country:US
Practice Address - Phone:202-702-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide