Provider Demographics
NPI:1568127769
Name:ALBASON, JUN JUN CAPOTE
Entity Type:Individual
Prefix:MR
First Name:JUN JUN
Middle Name:CAPOTE
Last Name:ALBASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 STONEGLEN WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-5605
Mailing Address - Country:US
Mailing Address - Phone:916-897-0948
Mailing Address - Fax:
Practice Address - Street 1:5125 STONEGLEN WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5605
Practice Address - Country:US
Practice Address - Phone:916-897-0948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD6611539Medicaid