Provider Demographics
NPI:1356670806
Name:CANDELARIO, DAVID M (RRT-NPS/RRT-SDS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:CANDELARIO
Suffix:
Gender:M
Credentials:RRT-NPS/RRT-SDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 HOMECREST AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-4352
Mailing Address - Country:US
Mailing Address - Phone:269-343-4421
Mailing Address - Fax:
Practice Address - Street 1:1612 HOMECREST AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-4352
Practice Address - Country:US
Practice Address - Phone:269-343-4421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS100129225500000X, 2278C0205X, 2279C0205X, 2279P3900X, 2279P1004X
MI44010043452279C0205X
CA268182279C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No2278C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedCritical Care
No2279P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredNeonatal/Pediatrics
No2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Diagnostics