Provider Demographics
NPI:1962778878
Name:CAPILI, CONRAD RODRIGUEZ (MD)
Entity type:Individual
Prefix:
First Name:CONRAD
Middle Name:RODRIGUEZ
Last Name:CAPILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 GREENVILLE AVE
Mailing Address - Street 2:STE N-108
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8515 GREENVILLE AVE
Practice Address - Street 2:STE N-108
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7011
Practice Address - Country:US
Practice Address - Phone:214-221-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-25
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ2978208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program