Provider Demographics
NPI:1962761437
Name:BOSLEY, CANEITA QUIARA (MD)
Entity type:Individual
Prefix:
First Name:CANEITA
Middle Name:QUIARA
Last Name:BOSLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CANEITA
Other - Middle Name:QUIARA
Other - Last Name:CREIGHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3208 N MACGREGOR WAY UNIT C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-8151
Mailing Address - Country:US
Mailing Address - Phone:810-869-3522
Mailing Address - Fax:
Practice Address - Street 1:2727 W HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1669
Practice Address - Country:US
Practice Address - Phone:713-442-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430111404208000000X
TXQ4074208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics