Provider Demographics
NPI:1457238818
Name:FABER, CANDICE ENJUWELL
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:ENJUWELL
Last Name:FABER
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 1:1910 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4529
Mailing Address - Country:US
Mailing Address - Phone:214-531-5371
Mailing Address - Fax:
Practice Address - Street 1:1910 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4529
Practice Address - Country:US
Practice Address - Phone:214-531-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies