Healthcare Provider Details

I. General information

NPI: 1275195760
Provider Name (Legal Business Name): NOELLE CAPULONG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 GATEWAY PLACE 5TH FLOOR, OFFICE 647
SAN JOSE CA
95110
US

IV. Provider business mailing address

68 HARRISON AVE STE 600
BOSTON MA
02111-1995
US

V. Phone/Fax

Practice location:
  • Phone: 657-500-0634
  • Fax:
Mailing address:
  • Phone: 657-500-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA53600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: