Healthcare Provider Details

I. General information

NPI: 1326113473
Provider Name (Legal Business Name): MARIO CARLO CAPOCELLI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 MCINTYRE ST
GOLDEN CO
80403-7445
US

IV. Provider business mailing address

1805 SHEA CENTER DR STE 301
HIGHLANDS RANCH CO
80129-2251
US

V. Phone/Fax

Practice location:
  • Phone: 720-434-4876
  • Fax: 303-225-4246
Mailing address:
  • Phone: 303-357-2559
  • Fax: 720-439-2456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1593
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: