Provider Demographics
NPI:1710479746
Name:KIRVEN-PRAYER, CANDACE YOLANDA
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:YOLANDA
Last Name:KIRVEN-PRAYER
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 1:150 FRANK H OGAWA PLZ STE 4340
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2092
Mailing Address - Country:US
Mailing Address - Phone:510-238-6130
Mailing Address - Fax:
Practice Address - Street 1:150 FRANK H OGAWA PLZ STE 4340
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2092
Practice Address - Country:US
Practice Address - Phone:510-238-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073934212Medicaid