Provider Demographics
NPI:1194589143
Name:CANAS, ADRIANA PATRICIA
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:PATRICIA
Last Name:CANAS
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 1:358 W 17TH ST # 4
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-4889
Mailing Address - Country:US
Mailing Address - Phone:310-756-5736
Mailing Address - Fax:
Practice Address - Street 1:292 S LA CIENEGA BLVD STE 250
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3357
Practice Address - Country:US
Practice Address - Phone:310-954-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist