Provider Demographics
NPI:1205962420
Name:OLSON & MADAYAG-CAPUNO,MDS
Entity type:Organization
Organization Name:OLSON & MADAYAG-CAPUNO,MDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-848-1582
Mailing Address - Street 1:PO BOX 1948
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-1948
Mailing Address - Country:US
Mailing Address - Phone:209-848-1582
Mailing Address - Fax:209-848-1584
Practice Address - Street 1:232 W F ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3844
Practice Address - Country:US
Practice Address - Phone:209-848-2273
Practice Address - Fax:209-848-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40340207R00000X, 207RI0200X
CAP65607363A00000X
CAG62203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A631670Medicaid
CAGR0056700Medicaid
CAZZZ14229ZMedicare PIN
CAA48192Medicare UPIN
CAP65607Medicare UPIN
CAZZZ14229ZMedicare ID - Type UnspecifiedGROUP MEDICARE PROVIDER
CA0PA151340Medicare PIN
CA00G403400Medicare PIN
CAGR0056700Medicaid
CA00A631670Medicare PIN