Provider Demographics
NPI:1407222482
Name:CANDELARIO -VIDRO, JEFFREY SR (RN)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:CANDELARIO -VIDRO
Suffix:SR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 9 BOX 4059
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-9426
Mailing Address - Country:US
Mailing Address - Phone:787-910-8329
Mailing Address - Fax:
Practice Address - Street 1:APS PUERTO RICO, AVE. HOSTOS OFFICE PARK 2,
Practice Address - Street 2:MEDICAL EMPORIUM, PISO 4, SUITE 406
Practice Address - City:MAYAGUEZ
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00680
Practice Address - Country:UM
Practice Address - Phone:787-641-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15327164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse