Healthcare Provider Details

I. General information

NPI: 1164488201
Provider Name (Legal Business Name): ANGELO CAPOZZI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 STOCKTON BLVD
SACRAMENTO CA
95817-2215
US

IV. Provider business mailing address

2425 STOCKTON BLVD
SACRAMENTO CA
95817-2215
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-2050
  • Fax: 916-453-2373
Mailing address:
  • Phone: 916-453-2050
  • Fax: 916-453-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberC28468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: