Provider Demographics
NPI:1154191013
Name:CANONIZADO, ARIEL KANANI
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:KANANI
Last Name:CANONIZADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 BREWSTER AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1709
Mailing Address - Country:US
Mailing Address - Phone:650-366-8436
Mailing Address - Fax:650-366-0220
Practice Address - Street 1:420 BREWSTER AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1709
Practice Address - Country:US
Practice Address - Phone:650-366-8436
Practice Address - Fax:650-366-0220
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program