MEDICARE: TRON CAPISTRANO

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	225100000X	Physical Therapist	43435	CA

General Provider Information

NPI Number	:	1780041863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRON CAPISTRANO

Provider Business Mailing Address
First Line	:	5581 DEER RUN DR
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94803-3871
Country	:	US
Telephone Number	:	510-965-8756
Fax Number	:

Provider Business Practice Location Address
First Line	:	5581 DEER RUN DR
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94803-3871
Country	:	US
Telephone Number	:	510-965-8756
Fax Number	:

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

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	01/21/2016

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Directions to “ TRON CAPISTRANO ” Practice Location

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