Provider Demographics
NPI:1306260856
Name:CANO, JULIETA SCHEREZADA (CCT)
Entity type:Individual
Prefix:
First Name:JULIETA
Middle Name:SCHEREZADA
Last Name:CANO
Suffix:
Gender:F
Credentials:CCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14624 SHERMAN WAY
Mailing Address - Street 2:SUITE 406
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2241
Mailing Address - Country:US
Mailing Address - Phone:818-989-9991
Mailing Address - Fax:818-373-7383
Practice Address - Street 1:14624 SHERMAN WAY
Practice Address - Street 2:SUITE 406
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2241
Practice Address - Country:US
Practice Address - Phone:818-989-9991
Practice Address - Fax:818-373-7383
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00073956291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory