Provider Demographics
NPI:1902592355
Name:CANDELARIA, ADRIAN GABRIEL
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:GABRIEL
Last Name:CANDELARIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 N CAMPBELL AVE APT 5001
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1505
Mailing Address - Country:US
Mailing Address - Phone:818-402-7577
Mailing Address - Fax:
Practice Address - Street 1:5700 E PIMA ST STE E
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5637
Practice Address - Country:US
Practice Address - Phone:520-232-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider