MEDICARE: CANDACE MACATANGAY NP

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	363LF0000X	Family Nurse Practitioner	NP95004217	CA

General Provider Information

NPI Number	:	1841647641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE MACATANGAY NP

Provider Business Mailing Address
First Line	:	6129 SAINT CLAIR AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6129 SAINT CLAIR AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4631
Country	:	US
Telephone Number	:	323-377-1337
Fax Number	:

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

Provider Enumeration Date	:	05/21/2016
Last Update Date	:	05/21/2016

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