Healthcare Provider Details

I. General information

NPI: 1891347068
Provider Name (Legal Business Name): CANDACE MIDDLETON-KIDD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 CENTER DR STE E
LA MESA CA
91942-2952
US

IV. Provider business mailing address

500 AMALFI LOOP APT 484
MILPITAS CA
95035-8086
US

V. Phone/Fax

Practice location:
  • Phone: 619-466-6077
  • Fax:
Mailing address:
  • Phone: 901-672-2173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225B00000X
TaxonomyPulmonary Function Technologist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number36837
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: