Provider Demographics
NPI:1144455965
Name:CANDELARIO, JOSERODEL ZAVALA (DC)
Entity type:Individual
Prefix:
First Name:JOSERODEL
Middle Name:ZAVALA
Last Name:CANDELARIO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 BONITA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1700
Mailing Address - Country:US
Mailing Address - Phone:619-479-7473
Mailing Address - Fax:619-479-9376
Practice Address - Street 1:5030 BONITA RD
Practice Address - Street 2:SUITE B
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1700
Practice Address - Country:US
Practice Address - Phone:619-479-7473
Practice Address - Fax:619-479-9376
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28449111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC28449Medicare UPIN