Healthcare Provider Details

I. General information

NPI: 1336001957
Provider Name (Legal Business Name): GERALDINE CANDELARIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 S MYRTLE AVE
MONROVIA CA
91016-3427
US

IV. Provider business mailing address

902 S MYRTLE AVE
MONROVIA CA
91016-3427
US

V. Phone/Fax

Practice location:
  • Phone: 626-357-3258
  • Fax:
Mailing address:
  • Phone: 626-357-3258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number742433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: