Healthcare Provider Details

I. General information

NPI: 1669611679
Provider Name (Legal Business Name): PETER CAPONE-NEWTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD BUILDING 500, RM 1601
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

11301 WILSHIRE BLVD BUILDING 500, RM 1601
LOS ANGELES CA
90073-1003
US

V. Phone/Fax

Practice location:
  • Phone: 310-701-1289
  • Fax:
Mailing address:
  • Phone: 310-701-1289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA100379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: