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General NPI Number Information
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NPI Number | 1922871441
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Entity Type | Individual
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Provider Name | NATHAN CAPULONG
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Gender | Male
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 26302 LA PAZ RD STE 105
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City | MISSION VIEJO
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State | CA
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Zip | 92691-5327
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Country | US
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Telephone | 562-735-8112
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Fax |
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Provider Business Mailing Address
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Address Line | 204 LAUREL AVE
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City | BREA
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State | CA
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Zip | 92821-5542
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Country | US
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Telephone | 310-561-5911
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 52859
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License Number State | CA
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