Provider Demographics
NPI:1649381781
Name:DALE CAPULONG MD, INC.
Entity Type:Organization
Organization Name:DALE CAPULONG MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:ANDRADE
Authorized Official - Last Name:CAPULONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-259-3803
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:95116-1604
Mailing Address - Country:US
Mailing Address - Phone:408-259-3803
Mailing Address - Fax:408-259-5956
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:95116-1604
Practice Address - Country:US
Practice Address - Phone:408-259-3803
Practice Address - Fax:408-259-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35266207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A88326Medicare UPIN