Provider Demographics
NPI:1811207624
Name:FAUSTO, CANDELARIA (LVN)
Entity Type:Individual
Prefix:
First Name:CANDELARIA
Middle Name:
Last Name:FAUSTO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7313 TRUCKEE AVE
Mailing Address - Street 2:
Mailing Address - City:GERBER
Mailing Address - State:CA
Mailing Address - Zip Code:96035-9760
Mailing Address - Country:US
Mailing Address - Phone:530-736-3511
Mailing Address - Fax:
Practice Address - Street 1:5 HILDA WAY
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1417
Practice Address - Country:US
Practice Address - Phone:530-899-3759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA239101164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse