Provider Demographics
NPI:1902207335
Name:PATRICIA GRACE DANGO-CAPATI DBA SUPERIOR CARE CLINIC
Entity Type:Organization
Organization Name:PATRICIA GRACE DANGO-CAPATI DBA SUPERIOR CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:DANGO-CAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-602-8194
Mailing Address - Street 1:3204 N MACARTHUR BLVD
Mailing Address - Street 2:BUILDING A
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-4453
Mailing Address - Country:US
Mailing Address - Phone:817-602-8194
Mailing Address - Fax:
Practice Address - Street 1:3204 N MACARTHUR BLVD
Practice Address - Street 2:BUILDING A
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4453
Practice Address - Country:US
Practice Address - Phone:817-602-8194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X, 207QA0505X, 207R00000X, 363A00000X, 363AM0700X, 363LF0000X, 363LP0200X
208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty