Provider Demographics
NPI:1508514837
Name:CANDELARIA, JULIA (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:CANDELARIA
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 AGATE ST APT A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1279
Mailing Address - Country:US
Mailing Address - Phone:760-291-7349
Mailing Address - Fax:
Practice Address - Street 1:7522 LA JOLLA BLVD
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4720
Practice Address - Country:US
Practice Address - Phone:858-900-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19116171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist