MEDICARE: DR. SUZETTE CANDELARIO M.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	208000000X	Pediatrics Physician	9724	PR

General Provider Information

NPI Number	:	1528032968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZETTE CANDELARIO M.D.

Provider Business Mailing Address
First Line	:	2639 CALLE PONTEVEDRA
Second Line	:	URB. ANAIDA
City	:	PONCE
State	:	PR
Zip	:	00716-3619
Country	:	US
Telephone Number	:	787-848-8614
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 CALLE LA CRUZ
Second Line	:	CENTRO SAN CRISTOBAL
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795-2426
Country	:	US
Telephone Number	:	787-837-2265
Fax Number	:

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	10/14/2020

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