Fernando Basco Canon, M.D.

Key facts

NPI

1174656102

Entity type

Individual (NPI type 1)

Primary specialty

Procedural Dermatology Physician 207NS0135X

License

A30070 (CA)

Practice address

8337 Telegraph Rd
Suite 210
Pico Rivera, CA 90660-4909

Phone

(562) 806-1321

Fax

(562) 806-0801

NPI assigned

Mar 13, 2007

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174656102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8337 TELEGRAPH RD",
            "address_2": "SUITE 210",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "906604909",
            "telephone_number": "562-806-1321",
            "fax_number": "562-806-0801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8337 TELEGRAPH RD",
            "address_2": "SUITE 210",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "906604909",
            "telephone_number": "562-806-1321",
            "fax_number": "562-806-0801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANON",
        "first_name": "FERNANDO",
        "middle_name": "BASCO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A30070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Pico Rivera, CA · Procedural Dermatology Physician in California