Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A66674 | CA |
NPI | 1053776740 |
---|---|
Provider Name | Dr. Miguel Canales |
First Address | Palo Alto, CA 94304-1800 |
Second Address | Palo Alto, CA 94304-1800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2015 |
Last Update Date | 22/12/2015 |