Healthcare Provider Details

I. General information

NPI: 1356670806
Provider Name (Legal Business Name): DAVID M CANDELARIO RRT-NPS/RRT-SDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 HOMECREST AVE
KALAMAZOO MI
49001-4352
US

IV. Provider business mailing address

1612 HOMECREST AVE
KALAMAZOO MI
49001-4352
US

V. Phone/Fax

Practice location:
  • Phone: 269-343-4421
  • Fax:
Mailing address:
  • Phone: 269-343-4421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number100129
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License Number100129
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number100129
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number4401004345
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number26818
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number100129
License Number StateKS
# 7
Primary TaxonomyN
Taxonomy Code2279P1004X
TaxonomyPulmonary Diagnostics Registered Respiratory Therapist
License Number100129
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: