Provider Demographics
NPI:1225624430
Name:CANDELARIO, JAVIER JR
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:CANDELARIO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3249
Mailing Address - Country:US
Mailing Address - Phone:440-787-8916
Mailing Address - Fax:
Practice Address - Street 1:5710 WILLIAMSBURG DR
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3249
Practice Address - Country:US
Practice Address - Phone:440-787-8916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide