MEDICARE: EDGARDO M CAPITULO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	A43464	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164454385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGARDO M CAPITULO MD

Provider Business Mailing Address
First Line	:	PO BOX 2416
Second Line	:
City	:	WINNETKA
State	:	CA
Zip	:	91396-2416
Country	:	US
Telephone Number	:	818-882-7656
Fax Number	:	818-773-9517

Provider Business Practice Location Address
First Line	:	1411 W SUNSET BLVD
Second Line	:	SUITE 203
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3431
Country	:	US
Telephone Number	:	818-882-7656
Fax Number	:	818-773-9517

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	10/20/2008

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