MEDICARE: NOELLE CAPULONG PA

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	363A00000X	Physician Assistant	PA53600	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA53600	OTHER	CA	PHYSICIAN ASSISTANT BOARD OF CALIFORNIA

General Provider Information

NPI Number	:	1275195760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOELLE CAPULONG PA

Provider Business Mailing Address
First Line	:	18800 DELAWARE ST STE 670
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-7605
Country	:	US
Telephone Number	:	424-403-2873
Fax Number	:

Provider Business Practice Location Address
First Line	:	18800 DELAWARE ST STE 670
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-7605
Country	:	US
Telephone Number	:	424-403-2873
Fax Number	:

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

Provider Enumeration Date	:	07/03/2019
Last Update Date	:	07/03/2019

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Directions to “ NOELLE CAPULONG PA” Practice Location

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