Provider Demographics
NPI:1922816701
Name:CANONOY, JEFFREY D (BSN, PMHRN-BC, RN)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:CANONOY
Suffix:
Gender:M
Credentials:BSN, PMHRN-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15735 NORDHOFF ST UNIT 22
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3155
Mailing Address - Country:US
Mailing Address - Phone:909-231-3182
Mailing Address - Fax:
Practice Address - Street 1:150 UCLA MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-8313
Practice Address - Country:US
Practice Address - Phone:310-267-7418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029468163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult