Provider Demographics
NPI:1114228350
Name:CANDELARIA, MICHAEL A (LMT, NTS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:CANDELARIA
Suffix:
Gender:M
Credentials:LMT, NTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10608 APACHE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3024
Mailing Address - Country:US
Mailing Address - Phone:505-715-3893
Mailing Address - Fax:
Practice Address - Street 1:9412 INDIAN SCHOOL RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2878
Practice Address - Country:US
Practice Address - Phone:505-505-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist