Provider Demographics
NPI:1043694532
Name:CANDELARIO-VELAZQUEZ, CORAL
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:
Last Name:CANDELARIO-VELAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W GORE ST STE 600
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1051
Mailing Address - Country:US
Mailing Address - Phone:321-842-4067
Mailing Address - Fax:321-843-6521
Practice Address - Street 1:100 W GORE ST STE 600
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1051
Practice Address - Country:US
Practice Address - Phone:321-842-4067
Practice Address - Fax:321-843-6521
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1501222081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine