Provider Demographics
NPI:1235363276
Name:SPROTT, CANDACE I (MD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:I
Last Name:SPROTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:I
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:732 N BROADWAY
Mailing Address - Street 2:2ND FLOOR PRIMARY CARE
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1870
Mailing Address - Country:US
Mailing Address - Phone:760-839-7100
Mailing Address - Fax:760-839-7052
Practice Address - Street 1:732 N BROADWAY
Practice Address - Street 2:2ND FLOOR PRIMARY CARE
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1870
Practice Address - Country:US
Practice Address - Phone:760-839-7100
Practice Address - Fax:760-839-7052
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142329208000000X, 207R00000X
DEC1-0010403208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine