Provider Demographics
NPI:1457458051
Name:CAPULONG, DALE ANDRADA (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:ANDRADA
Last Name:CAPULONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 N JACKSON AVE
Mailing Address - Street 2:#102
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116
Mailing Address - Country:US
Mailing Address - Phone:408-259-3803
Mailing Address - Fax:408-259-5950
Practice Address - Street 1:244 N JACKSON AVE
Practice Address - Street 2:#102
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116
Practice Address - Country:US
Practice Address - Phone:408-259-3803
Practice Address - Fax:408-259-5950
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA770007752207V00000X
CAA35266207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A88326Medicare UPIN