Healthcare Provider Details

I. General information

NPI: 1225480346
Provider Name (Legal Business Name): JOSE EDUARDO VICENTE CANDELARIO MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E ORANGEBURG AVE STE 16
MODESTO CA
95350-5340
US

IV. Provider business mailing address

1131 COLORADO AVE APT 101
TURLOCK CA
95380-2700
US

V. Phone/Fax

Practice location:
  • Phone: 209-585-3321
  • Fax:
Mailing address:
  • Phone: 760-905-2479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11937992
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: