MEDICARE: GEORGINA MELANIE CAPELOUTO M.ED., BCBA

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	106S00000X	Behavior Technician		CA
2	103K00000X	Behavior Analyst	1-26-89080	CA

General Provider Information

NPI Number	:	1447954383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGINA MELANIE CAPELOUTO M.ED., BCBA

Provider Business Mailing Address
First Line	:	245 KENNEBEC AVE APT 2
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5769
Country	:	US
Telephone Number	:	323-273-1808
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 KENNEBEC AVE APT 2
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5769
Country	:	US
Telephone Number	:	323-273-1808
Fax Number	:

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

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	04/22/2026

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