Provider Demographics
NPI:1396029419
Name:CAPOTE'S INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:CAPOTE'S INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-260-0706
Mailing Address - Street 1:937 SW 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2406
Mailing Address - Country:US
Mailing Address - Phone:813-260-0706
Mailing Address - Fax:
Practice Address - Street 1:937 SW 122ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2406
Practice Address - Country:US
Practice Address - Phone:813-260-0706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104299261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL146A8OtherB/C BS
FL001388500Medicaid
FL001388500Medicaid