Provider Demographics
NPI:1679329650
Name:DEL RIO CANDIA, ADRIANO
Entity type:Individual
Prefix:
First Name:ADRIANO
Middle Name:
Last Name:DEL RIO CANDIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 WINKLER AVE APT 409
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-8420
Mailing Address - Country:US
Mailing Address - Phone:239-365-9692
Mailing Address - Fax:
Practice Address - Street 1:3421 WINKLER AVE APT 409
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-8420
Practice Address - Country:US
Practice Address - Phone:239-365-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-335291106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician