Provider Demographics
NPI:1962270355
Name:CAPOBIANCO, KARLA HOSTETTER (BA)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:HOSTETTER
Last Name:CAPOBIANCO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 STOUTS LN STE 11
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-1914
Mailing Address - Country:US
Mailing Address - Phone:732-407-2743
Mailing Address - Fax:
Practice Address - Street 1:45 STOUTS LN STE 11
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-1914
Practice Address - Country:US
Practice Address - Phone:732-407-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ223382158171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach