MEDICARE: JULIAN CAPITO MLS

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	246RM2200X	Medical Laboratory Technician	240067	OH

General Provider Information

NPI Number	:	1821343211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIAN CAPITO MLS

Provider Business Mailing Address
First Line	:	2777 HAMPSHIRE RD APT 302
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-2539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2777 HAMPSHIRE RD APT 302
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-2539
Country	:	US
Telephone Number	:	330-635-1237
Fax Number	:

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

Provider Enumeration Date	:	07/21/2012
Last Update Date	:	07/21/2012

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Directions to “ JULIAN CAPITO MLS” Practice Location

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