Provider Demographics
NPI:1669525937
Name:CAPELOTO, BRIAN W (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:CAPELOTO
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 1:9042 GARFIELD AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2340
Mailing Address - Country:US
Mailing Address - Phone:714-729-4156
Mailing Address - Fax:
Practice Address - Street 1:9042 GARFIELD AVE STE 206
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-2340
Practice Address - Country:US
Practice Address - Phone:714-729-4156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68972208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
A32808Medicare UPIN