Provider Demographics
NPI:1619934098
Name:KENTON, CANDACE CAMPOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:CAMPOS
Last Name:KENTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CANDACE
Other - Middle Name:VICTORIA
Other - Last Name:CAMPOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:302 W LYNWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2592
Mailing Address - Country:US
Mailing Address - Phone:210-393-5106
Mailing Address - Fax:
Practice Address - Street 1:302 W LYNWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2592
Practice Address - Country:US
Practice Address - Phone:210-393-5106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK54762080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G1792OtherMEDICAR NUMBER
TX8G1792OtherMEDICAR NUMBER