Provider Demographics
NPI:1740643501
Name:MORENO, CANDICE ODETTE (MD)
Entity type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:ODETTE
Last Name:MORENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CANDICE
Other - Middle Name:ODETTE
Other - Last Name:ROJAS-MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1000 W CARSON ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2004
Mailing Address - Country:US
Mailing Address - Phone:310-222-2301
Mailing Address - Fax:310-328-0864
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-2301
Practice Address - Fax:310-328-0864
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA153903208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics