MEDICARE: DR. DAVID L CAPACCIO DO

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	207R00000X	Internal Medicine Physician	20A18668	CA
2	207R00000X	Internal Medicine Physician	206544	NY
3	207R00000X	Internal Medicine Physician	9497	AZ
4	208M00000X	Hospitalist Physician	20A18668	CA

General Provider Information

NPI Number	:	1457355364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID L CAPACCIO DO

Provider Business Mailing Address
First Line	:	1165 MONTGOMERY DR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-4801
Country	:	US
Telephone Number	:	707-547-5437
Fax Number	:	707-547-5430

Provider Business Practice Location Address
First Line	:	1165 MONTGOMERY DR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-4801
Country	:	US
Telephone Number	:	707-547-5437
Fax Number	:	707-547-5430

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/23/2024

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