Provider Demographics
NPI:1194811984
Name:CANAVAN, FRANK PAUL (PA-C)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:PAUL
Last Name:CANAVAN
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:9754 SHADOW SPRINGS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557
Mailing Address - Country:US
Mailing Address - Phone:951-242-8774
Mailing Address - Fax:909-931-2477
Practice Address - Street 1:440 N. MOUNTAIN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-931-4034
Practice Address - Fax:909-931-2477
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA-11398363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant