Provider Demographics
NPI:1245651967
Name:CARANDANG, EDWIN C (SA-C)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:C
Last Name:CARANDANG
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 GLANTZ DR
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-3043
Mailing Address - Country:US
Mailing Address - Phone:440-397-0542
Mailing Address - Fax:
Practice Address - Street 1:777 GLANTZ DR
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-3043
Practice Address - Country:US
Practice Address - Phone:440-397-0542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant