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General NPI Number Information
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NPI Number | 1588372775
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Entity Type | Individual
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Provider Name | RON CANDELARIA LMT
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Gender | Male
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 106 LA PAZ PL
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City | CEDAR CREEK
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State | TX
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Zip | 78612-3669
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Country | US
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Telephone | 214-587-9323
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Fax | 787-200-8307
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Provider Business Mailing Address
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Address Line | PO BOX 178
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City | DEL VALLE
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State | TX
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Zip | 78617-0178
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Country | US
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Telephone | 214-587-9323
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Fax | 787-200-8307
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT039164
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License Number State | TX
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