Provider Demographics
NPI:1417178757
Name:CAPACIO, EDGAR SORTIGOSA (AOD COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:SORTIGOSA
Last Name:CAPACIO
Suffix:
Gender:M
Credentials:AOD COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 PASEO AURORA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-4867
Mailing Address - Country:US
Mailing Address - Phone:619-946-4226
Mailing Address - Fax:
Practice Address - Street 1:1031 25TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2102
Practice Address - Country:US
Practice Address - Phone:619-232-6454
Practice Address - Fax:619-235-4607
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)