Provider Demographics
NPI:1972558625
Name:CAPOTE, AVIS TERESITA (MD)
Entity Type:Individual
Prefix:MS
First Name:AVIS
Middle Name:TERESITA
Last Name:CAPOTE
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 1:6222 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4810
Mailing Address - Country:US
Mailing Address - Phone:305-221-5115
Mailing Address - Fax:305-221-5282
Practice Address - Street 1:6222 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4810
Practice Address - Country:US
Practice Address - Phone:305-221-5115
Practice Address - Fax:305-221-5282
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92968208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274243800Medicaid
FL32641OtherBCBS