Provider Demographics
NPI:1609545672
Name:CAPUNO, MAUREEN QUIAMBAO
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:QUIAMBAO
Last Name:CAPUNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10853 SUNNY MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2072
Mailing Address - Country:US
Mailing Address - Phone:858-859-5147
Mailing Address - Fax:
Practice Address - Street 1:10853 SUNNY MEADOW ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2072
Practice Address - Country:US
Practice Address - Phone:858-859-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95230852163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty