Healthcare Provider Details

I. General information

NPI: 1649740978
Provider Name (Legal Business Name): YALITZA FLOR CANDELARIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 ALGONKIN LOOP
ORLANDO FL
32828-5265
US

IV. Provider business mailing address

1150 S SEMORAN BLVD
ORLANDO FL
32807-1460
US

V. Phone/Fax

Practice location:
  • Phone: 407-388-4000
  • Fax:
Mailing address:
  • Phone: 800-867-7405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: