Healthcare Provider Details

I. General information

NPI: 1578228458
Provider Name (Legal Business Name): JACLYN CANDELAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 PAINTER AVE STE 201
WHITTIER CA
90602-3166
US

IV. Provider business mailing address

11037 BRINK AVE
NORWALK CA
90650-1837
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-6600
  • Fax:
Mailing address:
  • Phone: 562-455-7717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: