Healthcare Provider Details

I. General information

NPI: 1265711709
Provider Name (Legal Business Name): MARINA NOEMI CAPELLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 MISSION AVE UNIT 1
OCEANSIDE CA
92058-1351
US

IV. Provider business mailing address

3220 MISSION AVE UNIT 1
OCEANSIDE CA
92058-1351
US

V. Phone/Fax

Practice location:
  • Phone: 760-433-3155
  • Fax:
Mailing address:
  • Phone: 760-433-3155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA125409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: