Provider Demographics
NPI:1164858510
Name:CAPITOL FAMILY MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:CAPITOL FAMILY MEDICAL ASSOCIATES, INC
Other - Org Name:CAPITOL FAMILY MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:Q
Authorized Official - Last Name:DELGADILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-431-7384
Mailing Address - Street 1:4617 FREEPORT BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-2015
Mailing Address - Country:US
Mailing Address - Phone:916-431-7384
Mailing Address - Fax:916-244-9653
Practice Address - Street 1:4617 FREEPORT BLVD STE F
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-2015
Practice Address - Country:US
Practice Address - Phone:916-431-7384
Practice Address - Fax:916-244-9653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902842354Medicaid
CA2146331Medicare UPIN