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General NPI Number Information
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NPI Number | 1184241341
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Entity Type | Individual
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Provider Name | SERGIO ALEJANDRO CANDELAS MARTINEZ DC
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Gender | Male
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 13422 NEWPORT AVE STE G
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City | TUSTIN
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State | CA
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Zip | 92780-3746
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Country | US
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Telephone | 714-831-7772
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Fax | 714-884-3644
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Provider Business Mailing Address
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Address Line | 7887 LAMPSON AVE SPC 90
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City | GARDEN GROVE
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State | CA
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Zip | 92841-4122
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Country | US
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Telephone | 714-721-0503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 34840
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License Number State | CA
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