Provider Demographics
NPI:1063423952
Name:CANZONE, DAVID JOSEPH (DOM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
Last Name:CANZONE
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 OTOWI RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-986-9772
Mailing Address - Fax:
Practice Address - Street 1:2074 GALISTEO ST
Practice Address - Street 2:UNIT A2
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2138
Practice Address - Country:US
Practice Address - Phone:505-989-7418
Practice Address - Fax:505-986-8874
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM195RX1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist