Provider Demographics
NPI:1811426828
Name:CAPILI, JOSEPHINE KRISTY (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:KRISTY
Last Name:CAPILI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:KRISTY
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1252 GOLDEN COAST LN
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2365
Mailing Address - Country:US
Mailing Address - Phone:909-979-4798
Mailing Address - Fax:
Practice Address - Street 1:2623 E SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2926
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant