Basic Information
| Provider Information | |||||||||
| NPI: | 1295352193 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAPULONG | ||||||||
| FirstName: | ALEXANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 735 TARAVAL ST APT B | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941162594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096793957 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2919 MISSION ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941103917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152290500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2020 | ||||||||
| LastUpdateDate: | 09/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103T00000X | N | Behavioral Health & Social Service Providers | Psychologist | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.