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General NPI Number Information
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NPI Number | 1346877644
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Entity Type | Individual
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Provider Name | LESLIE CAPULONG MD
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Gender | Female
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 415 E MADISON ST
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City | SOUTH BEND
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State | IN
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Zip | 46617-2322
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Country | US
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Telephone | 574-283-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 5776 GRAPE RD STE 51 PMB 190
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City | MISHAWAKA
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State | IN
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Zip | 46545-8460
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Country | US
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Telephone | 347-504-0301
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Fax | 201-733-1176
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01096917A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 325281
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License Number State | NY
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