# RENE AB CAPULONG MDPA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124064456
- **Authorized official:** RENE AB CAPULONG MD (PRESIDENT SURGEON)
- **Authorized official phone:** (386) 736-7600

## Contact information

- **Practice address:** 2511 JUNIOR ST, ORANGE CITY, FL 32763-8000
- **Practice address phone:** (386) 736-7600
- **Practice address fax:** (386) 738-4649
- **Mailing address:** PO BOX 310, DE LEON SPRINGS, FL 32130-0310
- **Mailing address phone:** (386) 736-7600
- **Mailing address fax:** (386) 738-4649

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | ME17644 | FL | Yes |

## Other

- **Enumeration date:** 06/22/2006
- **Last updated:** 07/21/2022