Provider Demographics
NPI:1376578021
Name:CANDELARIA, CARMEN MARIA SANTIAGO (19835)
Entity Type:Individual
Prefix:MS
First Name:CARMEN MARIA
Middle Name:SANTIAGO
Last Name:CANDELARIA
Suffix:
Gender:F
Credentials:19835
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-0350
Mailing Address - Country:US
Mailing Address - Phone:787-262-3520
Mailing Address - Fax:
Practice Address - Street 1:1551 CALLE ALDA STE 201
Practice Address - Street 2:URB. CARIBE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2709
Practice Address - Country:US
Practice Address - Phone:787-281-0810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19835163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice