Provider Demographics
NPI:1316440555
Name:POLENDO, CANDY ANGELITA (RN)
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:ANGELITA
Last Name:POLENDO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CANDY
Other - Middle Name:ANGELITA
Other - Last Name:G. POLENDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:7832 PONY LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-2632
Mailing Address - Country:US
Mailing Address - Phone:210-727-0778
Mailing Address - Fax:
Practice Address - Street 1:7330 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6235
Practice Address - Country:US
Practice Address - Phone:210-737-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX886322163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse