Provider Demographics
NPI:1477863249
Name:CARMEN CAPODANN MD INC
Entity Type:Organization
Organization Name:CARMEN CAPODANN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPODANNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-831-1272
Mailing Address - Street 1:1360 W 6TH ST STE 270
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3539
Mailing Address - Country:US
Mailing Address - Phone:310-831-1272
Mailing Address - Fax:310-831-1273
Practice Address - Street 1:1360 W 6TH ST STE 270
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3539
Practice Address - Country:US
Practice Address - Phone:310-831-1272
Practice Address - Fax:310-831-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty