Provider Demographics
NPI:1508875832
Name:CANDA, CHERISH ANGELIC OBENZA (PT)
Entity Type:Individual
Prefix:
First Name:CHERISH ANGELIC
Middle Name:OBENZA
Last Name:CANDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-1909
Mailing Address - Country:US
Mailing Address - Phone:209-267-4419
Mailing Address - Fax:209-476-8747
Practice Address - Street 1:5910 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-4704
Practice Address - Country:US
Practice Address - Phone:209-475-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 24493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist