Provider Demographics
NPI:1568154425
Name:TERMINEL, CANDICE JO ANNE
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:JO ANNE
Last Name:TERMINEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W WHITE PARK DR
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-1021
Mailing Address - Country:US
Mailing Address - Phone:520-761-3902
Mailing Address - Fax:520-761-3904
Practice Address - Street 1:100 W WHITE PARK DR
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-1021
Practice Address - Country:US
Practice Address - Phone:520-761-3902
Practice Address - Fax:520-761-3904
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2594156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician