Provider Demographics
NPI:1558793158
Name:CANDELAS, DIEGO SANCHEZ (LMT)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:SANCHEZ
Last Name:CANDELAS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3859 VAN ESS COURT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012
Mailing Address - Country:US
Mailing Address - Phone:575-405-4133
Mailing Address - Fax:
Practice Address - Street 1:3961 E. LOHMAN AVE. STE.34
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-525-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7181172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist