NPI 1063057149
Derrick Cannon
Practice location
- Address
- 820 E Gilbert St, San Bernardino, CA 92415-1403
- Phone
- (909) 388-5644
- Mailing address
- 201 W Mill St, San Bernardino, CA 92408-1403
Registered specialties
Peer Specialist
Primary
Registry record
- NPI
- 1063057149
- Entity type
- Individual
- Sex (as registered)
- Male
- NPI issued
- 12 Nov 2019
- Record last updated
- 26 Nov 2019
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.