Organization
RENE AB CAPULONG MDPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENE AB CAPULONG MD (PRESIDENT SURGEON)
(386) 736-7600
Entity
Organization
Contact information
Practice address
2511 JUNIOR ST, ORANGE CITY, FL 32763-8000
(386) 736-7600
(386) 738-4649
Mailing address
PO BOX 310, DE LEON SPRINGS, FL 32130-0310
(386) 736-7600
(386) 738-4649
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
ME17644
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
053163400
—
FL
Enumeration date
06/22/2006
Last updated
07/21/2022
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