Provider Demographics
NPI:1588976997
Name:CAPOTE FERNANDEZ, CARLOS RAFAEL
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:RAFAEL
Last Name:CAPOTE FERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5524 S TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-2532
Mailing Address - Country:US
Mailing Address - Phone:407-257-2945
Mailing Address - Fax:
Practice Address - Street 1:5524 S TEXAS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-2532
Practice Address - Country:US
Practice Address - Phone:407-257-2945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036640363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily