MEDICARE: ARIONE D CAPOLUPO MFT

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	106H00000X	Marriage & Family Therapist	MFC39729	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MFC39729	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1174667026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIONE D CAPOLUPO MFT

Provider Business Mailing Address
First Line	:	25885 TRABUCO RD
Second Line	:	SUITE 5
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-6602
Country	:	US
Telephone Number	:	714-437-7400
Fax Number	:	714-437-7410

Provider Business Practice Location Address
First Line	:	275 CENTENNIAL WAY
Second Line	:	SUITE 107
City	:	TUSTIN
State	:	CA
Zip	:	92780-3708
Country	:	US
Telephone Number	:	714-437-7400
Fax Number	:	714-437-7410

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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