Provider Demographics
NPI:1104430420
Name:MALTEZOS, CANDICE ROSEANN (CRT)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:ROSEANN
Last Name:MALTEZOS
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 VIRGINIA AVE APT 1610
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-3379
Mailing Address - Country:US
Mailing Address - Phone:239-465-8778
Mailing Address - Fax:
Practice Address - Street 1:1925 VIRGINIA AVE APT 1610
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3379
Practice Address - Country:US
Practice Address - Phone:239-465-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT91792278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care