Healthcare Provider Details

I. General information

NPI: 1336348648
Provider Name (Legal Business Name): MR. JORDI CAPDET
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JORDI CAPDET L. AC.

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3446 PARK BLVD 204
SAN DIEGO CA
92103-5209
US

IV. Provider business mailing address

18128 CARL DR
JAMUL CA
91935-2647
US

V. Phone/Fax

Practice location:
  • Phone: 619-220-0747
  • Fax:
Mailing address:
  • Phone: 619-220-0747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCA8189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: