Provider Demographics
NPI:1285679936
Name:LUZ A. CANDELARIA,D.O.P.A.,DBA/CANDELARIA MEDICAL CENTER
Entity Type:Organization
Organization Name:LUZ A. CANDELARIA,D.O.P.A.,DBA/CANDELARIA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:CANDELARIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:915-591-1615
Mailing Address - Street 1:8269 NORTH LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-4234
Mailing Address - Country:US
Mailing Address - Phone:915-591-1615
Mailing Address - Fax:915-591-2875
Practice Address - Street 1:8269 NORTH LOOP ROAD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-4234
Practice Address - Country:US
Practice Address - Phone:915-591-1615
Practice Address - Fax:915-591-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0050BVMedicare PIN