Provider Demographics
NPI:1588380133
Name:CAPUL, JERICHO RAPHAEL GOMEZ (DPT)
Entity type:Individual
Prefix:
First Name:JERICHO
Middle Name:RAPHAEL GOMEZ
Last Name:CAPUL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:15741 MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3328
Mailing Address - Country:US
Mailing Address - Phone:951-314-4493
Mailing Address - Fax:
Practice Address - Street 1:4201 W CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1505
Practice Address - Country:US
Practice Address - Phone:833-574-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CATBD2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic