Provider Demographics
NPI:1396130779
Name:JUDITH K CAPORICCIO
Entity type:Organization
Organization Name:JUDITH K CAPORICCIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPORICCIO
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:509-736-6311
Mailing Address - Street 1:579 S 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-5080
Mailing Address - Country:US
Mailing Address - Phone:509-736-6311
Mailing Address - Fax:509-736-6336
Practice Address - Street 1:1601 COLUMBIA PARK TRL
Practice Address - Street 2:STE 103
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4772
Practice Address - Country:US
Practice Address - Phone:509-736-6311
Practice Address - Fax:509-736-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT 60057466175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty