MEDICARE: MRS. GLORIA R CAPPETTO DIPL. AC., L AC.

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	171100000X	Acupuncturist	198.000686	IL
2	171100000X	Acupuncturist	1250	CO
3	171100000X	Acupuncturist	ACU0001250	CO

General Provider Information

NPI Number	:	1215099940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GLORIA R CAPPETTO DIPL. AC., L AC.

Provider Business Mailing Address
First Line	:	1371 N WILL ROGERS DR
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81007-2339
Country	:	US
Telephone Number	:	719-778-6040
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 E SPAULDING AVE
Second Line	:	SUITE 8
City	:	PUEBLO WEST
State	:	CO
Zip	:	81007-1668
Country	:	US
Telephone Number	:	719-778-6040
Fax Number	:

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

Provider Enumeration Date	:	12/16/2006
Last Update Date	:	12/16/2013

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