Provider Demographics
NPI:1467219048
Name:MONTERO VARELA, CANDIDA (FNP)
Entity Type:Individual
Prefix:
First Name:CANDIDA
Middle Name:
Last Name:MONTERO VARELA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11146 LEADWELL ST
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-5048
Mailing Address - Country:US
Mailing Address - Phone:323-428-6688
Mailing Address - Fax:
Practice Address - Street 1:1201 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-2432
Practice Address - Country:US
Practice Address - Phone:323-588-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028984363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily