MEDICARE: HOWARD CAPON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	A179318	CA

General Provider Information

NPI Number	:	1053872549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOWARD CAPON MD

Provider Business Mailing Address
First Line	:	902 CIRBY WAY
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-4420
Country	:	US
Telephone Number	:	916-789-1798
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 CIRBY WAY
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-4420
Country	:	US
Telephone Number	:	916-789-1798
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	10/04/2022

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