Healthcare Provider Details

I. General information

NPI: 1124385158
Provider Name (Legal Business Name): ALLAN LAGDAMEN CAPOTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 CENTENNIAL PLAZA WAY
BAKERSFIELD CA
93312
US

IV. Provider business mailing address

10331 PARADISO WAY
BAKERSFIELD CA
93306-7879
US

V. Phone/Fax

Practice location:
  • Phone: 661-387-8333
  • Fax: 661-241-4052
Mailing address:
  • Phone: 661-301-0402
  • Fax: 661-742-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA123778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: