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MRS. IDA CANLAS RN, LVN

>> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1285254151

Individual Registrant:
MRS. IDA  CANLAS RN, LVN
Gender: F
Sole Proprietor

Location and contact information for practice:
409 LUPINE PL  LA VERNE, CA 91750-5734 US
Tel: 909-973-9221  Fax: --

Contact information for business:
409 LUPINE PL  LA VERNE, CA 91750-5734 US
Tel: 909-973-9221  Fax: --

Registration Information:
NPI: 1285254151
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363L00000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
CAVNH7280

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
7402017CA05




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