Provider Demographics
NPI:1154773091
Name:RODELO, CANDELARIA (CNA)
Entity type:Individual
Prefix:
First Name:CANDELARIA
Middle Name:
Last Name:RODELO
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19108 MILLS CHOICE RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3808
Mailing Address - Country:US
Mailing Address - Phone:301-915-4444
Mailing Address - Fax:
Practice Address - Street 1:19108 MILLS CHOICE RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-3808
Practice Address - Country:US
Practice Address - Phone:301-915-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-04
Last Update Date:2016-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00118341376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide