Provider Demographics
NPI:1346264967
Name:CANDIOTTI, CAROL (NP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:CANDIOTTI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 DEER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8577
Mailing Address - Country:US
Mailing Address - Phone:925-813-3400
Mailing Address - Fax:
Practice Address - Street 1:5601 DEER VALLEY RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8577
Practice Address - Country:US
Practice Address - Phone:925-813-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP7040/363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP17828/ZZZ207242Medicare UPIN