Provider Demographics
NPI:1184241341
Name:CANDELAS MARTINEZ, SERGIO ALEJANDRO (DC)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:ALEJANDRO
Last Name:CANDELAS MARTINEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7887 LAMPSON AVE SPC 90
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-4122
Mailing Address - Country:US
Mailing Address - Phone:714-721-0503
Mailing Address - Fax:
Practice Address - Street 1:13422 NEWPORT AVE STE G
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3746
Practice Address - Country:US
Practice Address - Phone:714-831-7772
Practice Address - Fax:714-884-3644
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor