Provider Demographics
NPI:1114230885
Name:FERNANDEZ, CANDACE JANNA (DPT)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:JANNA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8996 MIRAMAR RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4451
Mailing Address - Country:US
Mailing Address - Phone:858-397-2511
Mailing Address - Fax:760-979-0018
Practice Address - Street 1:8996 MIRAMAR RD STE 220
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4451
Practice Address - Country:US
Practice Address - Phone:858-397-2511
Practice Address - Fax:760-979-0018
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10873225100000X
CA293720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist