Provider Demographics
NPI:1366602146
Name:CANALES, ROSEMARY JANE (CNP)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:JANE
Last Name:CANALES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 MICHELSON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-0693
Mailing Address - Country:US
Mailing Address - Phone:888-227-3312
Mailing Address - Fax:
Practice Address - Street 1:350 JOHN MUIR PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5183
Practice Address - Country:US
Practice Address - Phone:925-513-6533
Practice Address - Fax:925-513-4957
Is Sole Proprietor?:No
Enumeration Date:2008-06-14
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10058-NP363LF0000X
NMCNP01610363LF0000X
CA22958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2851552Medicaid
KY7100050140Medicaid
KY7100050140Medicaid