Healthcare Provider Details

I. General information

NPI: 1821343211
Provider Name (Legal Business Name): JULIAN CAPITO MLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2012
Last Update Date: 07/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 HAMPSHIRE RD APT 302
CLEVELAND HEIGHTS OH
44106-2539
US

IV. Provider business mailing address

2777 HAMPSHIRE RD APT 302
CLEVELAND HEIGHTS OH
44106-2539
US

V. Phone/Fax

Practice location:
  • Phone: 330-635-1237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number240067
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: