Provider Demographics
NPI:1013353549
Name:CAPISTRANO, CIELITO BLANCO (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CIELITO
Middle Name:BLANCO
Last Name:CAPISTRANO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:CIELITO
Other - Middle Name:
Other - Last Name:BLANCO-CAPISTRANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, FNP-C
Mailing Address - Street 1:7341 FALL WAY
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-1043
Mailing Address - Country:US
Mailing Address - Phone:951-601-2299
Mailing Address - Fax:
Practice Address - Street 1:4310 ORANGE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3829
Practice Address - Country:US
Practice Address - Phone:951-781-6335
Practice Address - Fax:951-781-6365
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily