Healthcare Provider Details

I. General information

NPI: 1699750497
Provider Name (Legal Business Name): YESSENNIA CANDELARIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 MARYSVILLE BLVD
SACRAMENTO CA
95838-4512
US

IV. Provider business mailing address

3441 MARYSVILLE BLVD
SACRAMENTO CA
95838-4512
US

V. Phone/Fax

Practice location:
  • Phone: 916-563-7234
  • Fax: 916-679-5958
Mailing address:
  • Phone: 916-563-7234
  • Fax: 916-679-5958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13884
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC52575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: