MEDICARE: MR. DAVID EFREN CANDELARIA RN

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	163W00000X	Registered Nurse	162089	NM

General Provider Information

NPI Number	:	1740868348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID EFREN CANDELARIA RN

Provider Business Mailing Address
First Line	:	610 PALO DURO AVE NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-3833
Country	:	US
Telephone Number	:	505-267-7251
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 PALO DURO AVE NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-3833
Country	:	US
Telephone Number	:	505-267-7251
Fax Number	:

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

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	04/02/2021

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