MEDICARE: MR. JEFFREY MICHAEL CAPODANNO NP

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	363LA2100X	Acute Care Nurse Practitioner	21007	CA

General Provider Information

NPI Number	:	1518234699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY MICHAEL CAPODANNO NP

Provider Business Mailing Address
First Line	:	327 SAN JOSE AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-3710
Country	:	US
Telephone Number	:	415-609-8251
Fax Number	:

Provider Business Practice Location Address
First Line	:	327 SAN JOSE AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-3710
Country	:	US
Telephone Number	:	415-609-8251
Fax Number	:

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

Provider Enumeration Date	:	11/17/2011
Last Update Date	:	11/17/2011

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