Provider Demographics
NPI:1124056767
Name:CANALETTI, WILLIAM RICHARD III (PA-C)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RICHARD
Last Name:CANALETTI
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8700 WARNER AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3209
Mailing Address - Country:US
Mailing Address - Phone:714-850-7300
Mailing Address - Fax:714-850-7310
Practice Address - Street 1:8700 WARNER AVE STE 140
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3209
Practice Address - Country:US
Practice Address - Phone:714-850-7300
Practice Address - Fax:714-850-7310
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15662363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT17816Medicare UPIN
CAWPA15662AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER