Healthcare Provider Details

I. General information

NPI: 1902747769
Provider Name (Legal Business Name): CANDACE HAUGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 W GRAAF AVE
RIDGECREST CA
93555-2415
US

IV. Provider business mailing address

824 W GRAAF AVE
RIDGECREST CA
93555-2415
US

V. Phone/Fax

Practice location:
  • Phone: 844-784-5646
  • Fax:
Mailing address:
  • Phone: 844-784-5646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberCPA-02245259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: