Basic Information
| Provider Information | |||||||||
| NPI: | 1174791677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CANDELARIA | ||||||||
| FirstName: | INOCENCIO | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 34929 | ||||||||
| Address2: | P.O. BOX 39000 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941390001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259522828 | ||||||||
| FaxNumber: | 9259522850 | ||||||||
| Practice Location | |||||||||
| Address1: | 2305 CAMINO RAMON | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945831396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9258371886 | ||||||||
| FaxNumber: | 9258373913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2008 | ||||||||
| LastUpdateDate: | 06/18/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 43010886368 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 25MA08403600 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A106130 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.