Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | CA | |
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1063857738 |
---|---|
Provider Name | Mrs. Andrea Irene Canales |
First Address | Northridge, CA 91325-2003 |
Second Address | Van Nuys, CA 91405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2013 |
Last Update Date | 05/10/2018 |