Provider Demographics
NPI:1063529998
Name:CAPO DOMINGUEZ, FRANCISCO JOSE (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:JOSE
Last Name:CAPO DOMINGUEZ
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DR. PAVIA ST. 611
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2210
Mailing Address - Country:US
Mailing Address - Phone:787-727-4145
Mailing Address - Fax:787-268-5466
Practice Address - Street 1:DR. PAVIA ST. 611
Practice Address - Street 2:SUITE 104
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-2210
Practice Address - Country:US
Practice Address - Phone:787-727-4145
Practice Address - Fax:787-268-5466
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4375174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE-31157Medicare UPIN
PR25949Medicare ID - Type Unspecified