Provider Demographics
NPI:1528412228
Name:CAPOTE, EDINSON (RDA)
Entity Type:Individual
Prefix:
First Name:EDINSON
Middle Name:
Last Name:CAPOTE
Suffix:
Gender:M
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22283 S GARDEN AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-6043
Mailing Address - Country:US
Mailing Address - Phone:510-269-0427
Mailing Address - Fax:
Practice Address - Street 1:22283 S GARDEN AVE APT 9
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-6043
Practice Address - Country:US
Practice Address - Phone:510-269-0427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80983126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant