Healthcare Provider Details

I. General information

NPI: 1346209574
Provider Name (Legal Business Name): RICHARD ALLAN CAPPIELLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 KOKOPELLI BLVD UNIT D
FRUITA CO
81521-6306
US

IV. Provider business mailing address

PO BOX 130
FRUITA CO
81521-0130
US

V. Phone/Fax

Practice location:
  • Phone: 970-858-2590
  • Fax: 970-858-5036
Mailing address:
  • Phone: 970-858-2186
  • Fax: 970-858-2208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberDR.0057964
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: