Provider Demographics
NPI:1043332372
Name:CAPOZZA, CAROL MITCHELL (RD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MITCHELL
Last Name:CAPOZZA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:CAPOZZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD
Mailing Address - Street 1:8339 CHURCH ST STE 211
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4450
Mailing Address - Country:US
Mailing Address - Phone:408-847-8901
Mailing Address - Fax:408-847-4351
Practice Address - Street 1:777 1ST ST # 171
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4918
Practice Address - Country:US
Practice Address - Phone:408-847-8901
Practice Address - Fax:408-847-4351
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA674684133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered