Provider Demographics
NPI:1023501566
Name:CARANDANG, VLADY MANDO (RN)
Entity type:Individual
Prefix:
First Name:VLADY
Middle Name:MANDO
Last Name:CARANDANG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 ALLEGHANY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-1714
Mailing Address - Country:US
Mailing Address - Phone:619-948-7066
Mailing Address - Fax:
Practice Address - Street 1:5920 ALLEGHANY ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-1714
Practice Address - Country:US
Practice Address - Phone:619-948-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA749684163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse