Provider Demographics
NPI:1730971730
Name:CANONIGO, DEXTER NONATO (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:MR
First Name:DEXTER
Middle Name:NONATO
Last Name:CANONIGO
Suffix:
Gender:M
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 W GLENCREST AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3156
Mailing Address - Country:US
Mailing Address - Phone:818-454-2390
Mailing Address - Fax:
Practice Address - Street 1:2534 W GLENCREST AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3156
Practice Address - Country:US
Practice Address - Phone:818-454-2390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst