Provider Demographics
NPI:1568084150
Name:CANDELARIO, ETNY RAUL (MD)
Entity Type:Individual
Prefix:
First Name:ETNY
Middle Name:RAUL
Last Name:CANDELARIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1339 FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-1437
Mailing Address - Country:US
Mailing Address - Phone:210-923-4372
Mailing Address - Fax:210-923-5581
Practice Address - Street 1:1339 FAIR AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-1437
Practice Address - Country:US
Practice Address - Phone:210-923-4372
Practice Address - Fax:210-923-5581
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301510053207Q00000X
TXU6458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine