Provider Demographics
NPI:1497007348
Name:THOMAS, CANDICE (LAC)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAC
Mailing Address - Street 1:2362 S CAMINO SECO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-7958
Mailing Address - Country:US
Mailing Address - Phone:520-390-6767
Mailing Address - Fax:
Practice Address - Street 1:6085 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2319
Practice Address - Country:US
Practice Address - Phone:520-318-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0847171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist