Healthcare Provider Details

I. General information

NPI: 1457992125
Provider Name (Legal Business Name): MONICA CANDELORE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA TOLAR PT

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 ETHELDORE ST
MOSS BEACH CA
94038-9699
US

IV. Provider business mailing address

703 ETHELDORE ST
MOSS BEACH CA
94038-9699
US

V. Phone/Fax

Practice location:
  • Phone: 650-242-5095
  • Fax: 650-661-0688
Mailing address:
  • Phone: 650-242-5095
  • Fax: 650-661-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT306340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: