Provider Demographics
NPI:1326378100
Name:RISE MEDICAL CENTER A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RISE MEDICAL CENTER A PROFESSIONAL CORPORATION
Other - Org Name:R I S E WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDELARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-479-7473
Mailing Address - Street 1:5030 BONITA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1700
Mailing Address - Country:US
Mailing Address - Phone:619-479-7473
Mailing Address - Fax:619-479-9376
Practice Address - Street 1:5030 BONITA RD
Practice Address - Street 2:SUITE B
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1700
Practice Address - Country:US
Practice Address - Phone:619-479-7473
Practice Address - Fax:619-479-9376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28449111N00000X
CAA73257174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty