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General NPI Number Information
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NPI Number | 1851921134
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Entity Type | Individual
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Provider Name | VICTOR CANDELA JR. SUDCC-IV CS
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Gender | Male
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Dates
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Enumeration Date | 01/25/2020
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 1655 E 6TH ST STE B6
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City | CORONA
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State | CA
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Zip | 92879-1719
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Country | US
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Telephone | 951-254-3767
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Fax |
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Provider Business Mailing Address
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Address Line | 1655 E 6TH ST STE B6
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City | CORONA
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State | CA
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Zip | 92879-1719
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Country | US
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Telephone | 951-254-3767
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 11187
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 132717
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 132717
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License Number State | CA
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