Provider Demographics
NPI:1689698078
Name:CAPPICCILLE, DIANE L (CRNA)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:L
Last Name:CAPPICCILLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:SARMIENTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:1635 DIVISADERO ST
Mailing Address - Street 2:SUITE 625, BOX 1821
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-476-4029
Mailing Address - Fax:415-476-4150
Practice Address - Street 1:1600 DIVISADERO ST # C-355
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-885-7626
Practice Address - Fax:415-476-9516
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2930367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0029300Medicaid
CA0029300Medicare PIN