Provider Demographics
NPI:1366844672
Name:VALENCIA, CANDICE HIMELDA (BA)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:HIMELDA
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16105 VIA CORTO E
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-7123
Mailing Address - Country:US
Mailing Address - Phone:760-898-1174
Mailing Address - Fax:
Practice Address - Street 1:58945 BUSINESS CENTER DR #D
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7307
Practice Address - Country:US
Practice Address - Phone:760-228-9657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator