Provider Demographics
NPI:1023676848
Name:BURINGRUD, CANDACE LEAH (RADT-I)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:LEAH
Last Name:BURINGRUD
Suffix:
Gender:F
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 MISSION AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7110
Mailing Address - Country:US
Mailing Address - Phone:760-721-2781
Mailing Address - Fax:760-712-3195
Practice Address - Street 1:1400 N JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1650
Practice Address - Country:US
Practice Address - Phone:760-721-2781
Practice Address - Fax:760-712-3195
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1368101019101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)