Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | A55863 | CA |
N | 207VX0201X | Gynecologic Oncologist | MD23949 | OR |
NPI | 1255346763 |
---|---|
Provider Name | Fabio Cappuccini |
First Address | Orange, CA 92868-5900 |
Second Address | Orange, CA 92868-3201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 22/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
286555 | (05) | OR |
33-0065688 | OB GYN UNIVERSITY ASSOCIATES (01) | CA |
G90006 | (02) |