Basic Information
Provider Information
NPI: 1033119946
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAPPARELLI
FirstName: ANTHONY
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2160
Address2:  
City: MOORPARK
State: CA
PostalCode: 930202160
CountryCode: US
TelephoneNumber: 8187182301
FaxNumber: 8187182311
Practice Location
Address1: 375 ROLLING OAKS DR
Address2: SUITE 100
City: THOUSAND OAKS
State: CA
PostalCode: 913611023
CountryCode: US
TelephoneNumber: 8054977775
FaxNumber: 8055571074
Other Information
ProviderEnumerationDate: 07/21/2005
LastUpdateDate: 11/28/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300XG51479CAY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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