Healthcare Provider Details

I. General information

NPI: 1184241341
Provider Name (Legal Business Name): SERGIO ALEJANDRO CANDELAS MARTINEZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13422 NEWPORT AVE STE G
TUSTIN CA
92780-3746
US

IV. Provider business mailing address

7887 LAMPSON AVE SPC 90
GARDEN GROVE CA
92841-4122
US

V. Phone/Fax

Practice location:
  • Phone: 714-831-7772
  • Fax: 714-884-3644
Mailing address:
  • Phone: 714-721-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: