Provider Demographics
NPI:1134680564
Name:CANDARE, VANESSA JF (PA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:JF
Last Name:CANDARE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:FELICANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 W LA VETA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4203
Mailing Address - Country:US
Mailing Address - Phone:714-509-4077
Mailing Address - Fax:949-898-6012
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4203
Practice Address - Country:US
Practice Address - Phone:714-509-4077
Practice Address - Fax:949-898-6012
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56927207NP0225X
CAPA56927363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology