Provider Demographics
NPI:1427505932
Name:PATERNINA, CANDELARIA (PT)
Entity type:Individual
Prefix:
First Name:CANDELARIA
Middle Name:
Last Name:PATERNINA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 W 49TH PL STE 301
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3147
Mailing Address - Country:US
Mailing Address - Phone:305-392-1216
Mailing Address - Fax:305-513-5130
Practice Address - Street 1:1435 W 49TH PL STE 301
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3147
Practice Address - Country:US
Practice Address - Phone:305-392-1216
Practice Address - Fax:305-513-5130
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT10321OtherPT LICENSE