Healthcare Provider Details

I. General information

NPI: 1093630238
Provider Name (Legal Business Name): EILINEE MIRANDA CANDELARIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 KM. 29.4
VEGA ALTA PR
00962
US

IV. Provider business mailing address

U6 CALLE W
VEGA BAJA PR
00693-5643
US

V. Phone/Fax

Practice location:
  • Phone: 787-270-1854
  • Fax:
Mailing address:
  • Phone: 787-430-3569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number1032
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: