Healthcare Provider Details

I. General information

NPI: 1134348493
Provider Name (Legal Business Name): DAMARIS CANDELARIA BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DESEMBALCADERO 7 FINAL # 668 E-35 BO. SABANA
GUAYNABO PR
00963
US

IV. Provider business mailing address

P O BOX 3492
CATANO PR
00963-3492
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-7521
  • Fax: 787-763-2480
Mailing address:
  • Phone: 787-763-7521
  • Fax: 787-763-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26939
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: