MEDICARE: MR. MYRNA J CANDELARIO PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1086	PR

General Provider Information

NPI Number	:	1295781102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MYRNA J CANDELARIO PSY.D

Provider Business Mailing Address
First Line	:	PO BOX 367221
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-7221
Country	:	US
Telephone Number	:	787-708-9871
Fax Number	:	787-296-0720

Provider Business Practice Location Address
First Line	:	435 AVE HOSTOS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3014
Country	:	US
Telephone Number	:	787-708-9871
Fax Number	:	787-296-0720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/08/2007

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