Provider Demographics
NPI:1972878536
Name:SIQUIAN-PASTOR, CANDICE ELIZABETH
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:ELIZABETH
Last Name:SIQUIAN-PASTOR
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 1:2770 S MARYLAND PKWY
Mailing Address - Street 2:STE. 211
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1554
Mailing Address - Country:US
Mailing Address - Phone:702-675-3400
Mailing Address - Fax:702-675-3400
Practice Address - Street 1:2770 S MARYLAND PKWY
Practice Address - Street 2:STE 211
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1554
Practice Address - Country:US
Practice Address - Phone:702-675-3400
Practice Address - Fax:702-675-3403
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner