Provider Demographics
NPI:1740517945
Name:CAPUPUS, MARI KATRINA D (PA)
Entity type:Individual
Prefix:MS
First Name:MARI KATRINA
Middle Name:D
Last Name:CAPUPUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:MARI
Other - Middle Name:A
Other - Last Name:CAPUPUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:2706 W MOUNT DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3211
Mailing Address - Country:US
Mailing Address - Phone:361-980-0803
Mailing Address - Fax:
Practice Address - Street 1:2706 W MOUNT DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3211
Practice Address - Country:US
Practice Address - Phone:361-980-0803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06484363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00115WMedicare Oscar/Certification
TX8L21766Medicare PIN