Healthcare Provider Details

I. General information

NPI: 1114228350
Provider Name (Legal Business Name): MICHAEL A CANDELARIA LMT, NTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9412 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87112-2878
US

IV. Provider business mailing address

10608 APACHE AVE NE
ALBUQUERQUE NM
87112-3024
US

V. Phone/Fax

Practice location:
  • Phone: 505-505-2260
  • Fax:
Mailing address:
  • Phone: 505-715-3893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: