Provider Demographics
NPI:1104225390
Name:CANALES, JORGE (PATHOLOGIST ASSISTAN)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:CANALES
Suffix:
Gender:M
Credentials:PATHOLOGIST ASSISTAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 LAS PALMAS CIR
Mailing Address - Street 2:APT 722
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4200 LAS PALMAS CIR
Practice Address - Street 2:APT 722
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2791
Practice Address - Country:US
Practice Address - Phone:985-869-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist