Provider Demographics
NPI:1154516599
Name:CAPETANAKIS, MARIA R (DO)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:R
Last Name:CAPETANAKIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:455 E COLUMBIA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1620
Mailing Address - Country:US
Mailing Address - Phone:562-933-0400
Mailing Address - Fax:
Practice Address - Street 1:4150 REGENTS PARK ROW STE 355
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-9102
Practice Address - Country:US
Practice Address - Phone:858-457-2043
Practice Address - Fax:858-457-2092
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A8190208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics