Provider Demographics
NPI:1710617816
Name:CAPUZZI, MIA (PA-C)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:CAPUZZI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S KIMBERLY AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2223
Mailing Address - Country:US
Mailing Address - Phone:814-443-8266
Mailing Address - Fax:814-443-8261
Practice Address - Street 1:314 S KIMBERLY AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2223
Practice Address - Country:US
Practice Address - Phone:814-443-8266
Practice Address - Fax:814-443-8261
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA063598363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical