Provider Demographics
NPI:1497515977
Name:CANDELO GOMEZ, ESTEPHANIA (MD, MSC)
Entity Type:Individual
Prefix:DR
First Name:ESTEPHANIA
Middle Name:
Last Name:CANDELO GOMEZ
Suffix:
Gender:F
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CL. 18 #122-135, BARRIO PANCE TOWE L
Mailing Address - Street 2:WORK
Mailing Address - City:CALI
Mailing Address - State:VALLE DEL CAUCA
Mailing Address - Zip Code:760003
Mailing Address - Country:CO
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CL. 18 #122-135, BARRIO PANCE TOWE L
Practice Address - Street 2:WORK
Practice Address - City:CALI
Practice Address - State:VALLE DEL CAUCA
Practice Address - Zip Code:760003
Practice Address - Country:CO
Practice Address - Phone:692-555-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10982478390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program