Provider Demographics
NPI:1912500786
Name:PRICE, CANDICE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7522 LA JOLLA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:760-692-6570
Practice Address - Street 1:865 LAW ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2531
Practice Address - Country:US
Practice Address - Phone:310-994-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20075225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist