Organization Active NPI

Carlos R Canizales MD Inc

  • Cardiovascular Disease Physician
  • Upland, CA
National Provider Identifier
1790987568
Registry record updated Feb 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
CARLOS R CANIZALES MD INC
Practice address
685 N 13TH Ave
Suite 9
Upland, CA 91786-4916
Phone
(909) 981-5923
Fax
(909) 920-3054
NPI assigned
Jun 4, 2007
Last updated
Feb 23, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carlos R Canizales, M.D.NPI 1285690909
Title
Owner
Phone
(909) 981-5923

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary

Addresses

Primary practice location

685 N 13TH Ave
Suite 9
Upland, CA 91786-4916

Mailing address

305 N. 2ND Avenue
Suite 203
Upland, CA 91786
Phone (909) 981-5923

Other identifiers 1

IdentifierTypeStateIssuer
00A212830MedicaidCA

National Provider Directory

National Provider Directory

Locations

305 N 2nd Ave
Upland, CA 91786
Phone (909) 981-5923

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424649600000",
    "number": "1790987568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 N. 2ND AVENUE",
            "address_2": "SUITE 203",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "91786",
            "telephone_number": "909-981-5923",
            "fax_number": "909-920-3054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "685 N 13TH AVE",
            "address_2": "SUITE 9",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864916",
            "telephone_number": "909-981-5923",
            "fax_number": "909-920-3054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLOS R CANIZALES MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2015-02-23",
        "status": "A",
        "authorized_official_last_name": "CANIZALES",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-981-5923",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A212830",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.