Provider Demographics
NPI:1487480802
Name:CANDELARIA, KATHERINE NICOLE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:NICOLE
Last Name:CANDELARIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10562 SANTA FE DR UNIT 330
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2557
Mailing Address - Country:US
Mailing Address - Phone:626-329-2754
Mailing Address - Fax:
Practice Address - Street 1:10562 SANTA FE DR UNIT 330
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2557
Practice Address - Country:US
Practice Address - Phone:626-329-2754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator