Provider Demographics
NPI:1134232119
Name:MADAYAG-CAPUNO, ELAINE M (MD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:M
Last Name:MADAYAG-CAPUNO
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:PO BOX 1946
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-1946
Mailing Address - Country:US
Mailing Address - Phone:209-847-2920
Mailing Address - Fax:209-847-2892
Practice Address - Street 1:715 W F ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3736
Practice Address - Country:US
Practice Address - Phone:209-847-2920
Practice Address - Fax:209-847-2892
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G62203Medicare UPIN
G62203Medicare UPIN
CA00A631670Medicare ID - Type Unspecified