Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0101046016 | VA |
N | 2080N0001X | Neonatal-Perinatal Doctor | 0101046016 | VA |
NPI | 1063481851 |
---|---|
Provider Name | Dr. Carmencita M Canonizado |
First Address | Virginia Beach, VA 23455-6560 |
Second Address | Virginia Beach, VA 23455-6560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 18/05/2020 |