Provider Demographics
NPI:1295534428
Name:CAPO, GUSTAVO ENRIQUE (BS)
Entity type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:ENRIQUE
Last Name:CAPO
Suffix:
Gender:
Credentials:BS
Other - Prefix:MR
Other - First Name:GUSTAVO
Other - Middle Name:ENRIQUE
Other - Last Name:CAPO FERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:1120 15TH ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-8623
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-8623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program