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General NPI Number Information
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NPI Number | 1437268943
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Entity Type | Individual
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Provider Name | MARIO OSVALDO KAPUSTA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 5585 WESLAYAN ST
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City | HOUSTON
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State | TX
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Zip | 77005-1941
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Country | US
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Telephone | 713-349-8346
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Fax | 713-218-8346
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Provider Business Mailing Address
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Address Line | PO BOX 6730
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City | HOUSTON
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State | TX
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Zip | 77265-6730
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Country | US
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Telephone | 713-349-8346
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Fax | 713-218-8346
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 11435
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | F0537
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C42419
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | F0537
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License Number State | TX
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