Provider Demographics
NPI:1457355364
Name:CAPACCIO, DAVID L (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:CAPACCIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4801
Mailing Address - Country:US
Mailing Address - Phone:707-547-5437
Mailing Address - Fax:707-547-5430
Practice Address - Street 1:1165 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4801
Practice Address - Country:US
Practice Address - Phone:707-547-5437
Practice Address - Fax:707-547-5430
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A18668207R00000X, 208M00000X
NY206544207R00000X
AZ9497207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11121817OtherCAQH
NY206544OtherNYS LICENSE
AZAZ0768740OtherBLUE CROSS BLUE SHIELD
AZ7104077OtherAETNA HEALTHCARE
AZ870747258OtherTIN
ASG46157Medicare UPIN
AZAZ0768740OtherBLUE CROSS BLUE SHIELD