Provider Demographics
NPI:1588372775
Name:CANDELARIA, RON (LMT)
Entity type:Individual
Prefix:MR
First Name:RON
Middle Name:
Last Name:CANDELARIA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:DEL VALLE
Mailing Address - State:TX
Mailing Address - Zip Code:78617-0178
Mailing Address - Country:US
Mailing Address - Phone:214-587-9323
Mailing Address - Fax:787-200-8307
Practice Address - Street 1:106 LA PAZ PL
Practice Address - Street 2:
Practice Address - City:CEDAR CREEK
Practice Address - State:TX
Practice Address - Zip Code:78612-3669
Practice Address - Country:US
Practice Address - Phone:214-587-9323
Practice Address - Fax:787-200-8307
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT039164225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist