=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801543855
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARIUS JAYME CANDELARIO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2022
-----------------------------------------------------
Last Update Date | 04/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 590 W PUTNAM AVE
-----------------------------------------------------
City | PORTERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93257-3257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-784-5337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 590 W PUTNAM AVE
-----------------------------------------------------
City | PORTERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93257-3257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-784-5337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 95026603
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------