Provider Demographics
NPI:1790706612
Name:CAPILI, REGINA R (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:R
Last Name:CAPILI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3143
Mailing Address - Country:US
Mailing Address - Phone:817-481-5365
Mailing Address - Fax:817-424-3264
Practice Address - Street 1:1501 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3143
Practice Address - Country:US
Practice Address - Phone:817-481-5365
Practice Address - Fax:817-424-3264
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185173501Medicaid
TX185173502Medicaid
TXP000GG118Medicaid
TX185173501Medicaid
TX8L2284Medicare PIN
TX8F23499Medicare PIN