Individual
TATIANA CANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3917 WEST RD, LOS ALAMOS, NM 87544-2275
(505) 753-1866
Mailing address
PO BOX 129, LOS ALAMOS, NM 87544-0129
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
20040710
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37521225
—
NM
01
—
900521294
MEDICARE GROUP
NM
Enumeration date
07/08/2006
Last updated
04/22/2008
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