Provider Demographics
NPI:1831320860
Name:CANLAS, BIENVENIDO BANAL (MD)
Entity type:Individual
Prefix:DR
First Name:BIENVENIDO
Middle Name:BANAL
Last Name:CANLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 VALENCIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-2456
Mailing Address - Country:US
Mailing Address - Phone:909-963-8721
Mailing Address - Fax:
Practice Address - Street 1:3905 VALENCIA AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-2456
Practice Address - Country:US
Practice Address - Phone:909-963-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094110208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice