Healthcare Provider Details

I. General information

NPI: 1316294408
Provider Name (Legal Business Name): RONALD CAPORALE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 03/31/2024
Certification Date: 03/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 SLIDE RD STE J
LUBBOCK TX
79424-1517
US

IV. Provider business mailing address

5219 CITY BANK PKWY SUITE 35
LUBBOCK TX
79407-3544
US

V. Phone/Fax

Practice location:
  • Phone: 806-794-9378
  • Fax: 806-799-0691
Mailing address:
  • Phone: 806-761-0333
  • Fax: 806-785-7685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA07942
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: