Provider Demographics
NPI:1154957587
Name:CANETT, MARISOL (LVN)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:CANETT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:MARISOL
Other - Middle Name:
Other - Last Name:CANETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:31760 CASINO DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4561
Mailing Address - Country:US
Mailing Address - Phone:951-471-4600
Mailing Address - Fax:951-471-4623
Practice Address - Street 1:31764 CASINO DR
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2312
Practice Address - Country:US
Practice Address - Phone:951-471-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA233838164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse