MEDICARE: JUDITH K CAPORICCIO

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	175F00000X	Naturopath	NT 60057466	WA

General Provider Information

NPI Number	:	1396130779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDITH K CAPORICCIO

Provider Business Mailing Address
First Line	:	579 S 40TH AVE
Second Line	:
City	:	WEST RICHLAND
State	:	WA
Zip	:	99353-5080
Country	:	US
Telephone Number	:	509-736-6311
Fax Number	:	509-736-6336

Provider Business Practice Location Address
First Line	:	1601 COLUMBIA PARK TRL
Second Line	:	STE 103
City	:	RICHLAND
State	:	WA
Zip	:	99352-4772
Country	:	US
Telephone Number	:	509-736-6311
Fax Number	:	509-736-6336

Authorized Official
Title or Position	:	SUPERVISING PROVIDER
Name	:	DR. JUDITH CAPORICCIO
Credential	:	N.D.
Telephone Number	:	509-736-6311

Provider Enumeration Date	:	04/01/2015
Last Update Date	:	04/01/2015

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