Provider Demographics
NPI:1073330833
Name:CANEVARO, GIULIANA A
Entity type:Individual
Prefix:MRS
First Name:GIULIANA
Middle Name:A
Last Name:CANEVARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GIULIANA
Other - Middle Name:
Other - Last Name:CANEVARO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8610 VAN NUYS BLVD STE 1004
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-7216
Mailing Address - Country:US
Mailing Address - Phone:818-488-0286
Mailing Address - Fax:
Practice Address - Street 1:8610 VAN NUYS BLVD STE 1004
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-7216
Practice Address - Country:US
Practice Address - Phone:818-488-0286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70733156FX1800X
CA40983156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician