Provider Demographics
NPI:1649588203
Name:CANDELARIO, CARLA MARIA (LVN)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:MARIA
Last Name:CANDELARIO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:MARIA
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:2525 W GREENACRE AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3143
Mailing Address - Country:US
Mailing Address - Phone:714-348-0614
Mailing Address - Fax:714-723-0290
Practice Address - Street 1:2525 W GREENACRE AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3143
Practice Address - Country:US
Practice Address - Phone:714-348-0614
Practice Address - Fax:714-723-0290
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242920164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse