Provider Demographics
NPI:1275195760
Name:CAPULONG, NOELLE (PA)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:CAPULONG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18800 DELAWARE ST STE 670
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-7605
Mailing Address - Country:US
Mailing Address - Phone:424-403-2873
Mailing Address - Fax:
Practice Address - Street 1:18800 DELAWARE ST STE 670
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-7605
Practice Address - Country:US
Practice Address - Phone:424-403-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA53600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA53600OtherPHYSICIAN ASSISTANT BOARD OF CALIFORNIA