Provider Demographics
NPI:1326113473
Name:CAPOCELLI, MARIO CARLO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:CARLO
Last Name:CAPOCELLI
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1805 SHEA CENTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2251
Mailing Address - Country:US
Mailing Address - Phone:303-357-2559
Mailing Address - Fax:720-439-2456
Practice Address - Street 1:5920 MCINTYRE ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-7445
Practice Address - Country:US
Practice Address - Phone:720-434-4876
Practice Address - Fax:303-225-4246
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2020-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO1593363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95254072Medicaid