Provider Demographics
NPI:1255346763
Name:CAPPUCCINI, FABIO (MD)
Entity type:Individual
Prefix:
First Name:FABIO
Middle Name:
Last Name:CAPPUCCINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CITY BLVD W STE 1400
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-5900
Mailing Address - Country:US
Mailing Address - Phone:714-456-6026
Mailing Address - Fax:714-456-6632
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:BUILDING 29, SUITE 501
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-8000
Practice Address - Fax:714-456-8055
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55863207VX0201X
ORMD23949207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286555Medicaid
CA33-0065688OtherOB GYN UNIVERSITY ASSOCIATES