Provider Demographics
NPI:1982973137
Name:MOORE, CANDACE MAKEDA (MD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:MAKEDA
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 AVE. LAGUNA; APT 8H
Mailing Address - Street 2:CON. LAUNA GARDENS; APT. 8H
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979
Mailing Address - Country:US
Mailing Address - Phone:979-579-3402
Mailing Address - Fax:
Practice Address - Street 1:4 AVE LAGUNA APT 8H
Practice Address - Street 2:CON. LAUNA GARDENS; APT. 8H
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-6574
Practice Address - Country:US
Practice Address - Phone:979-579-3402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13058-I207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine