Healthcare Provider Details

I. General information

NPI: 1134680564
Provider Name (Legal Business Name): VANESSA J.F. CANDARE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA FELICANO

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-4077
  • Fax: 949-898-6012
Mailing address:
  • Phone: 714-509-4077
  • Fax: 949-898-6012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number56927
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA56927
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: