Basic Information
| Provider Information | |||||||||
| NPI: | 1487689436 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOONEY | ||||||||
| FirstName: | CANDACE | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 N DATE ST | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920253413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7605208300 | ||||||||
| FaxNumber: | 7607372024 | ||||||||
| Practice Location | |||||||||
| Address1: | 41715 WINCHESTER RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925904808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517191414 | ||||||||
| FaxNumber: | 9517193158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 11/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 03225402 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 1805 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.