Individual provider Active NPI

Mark David Capitolo, MFT

  • Marriage & Family Therapist
  • San Rafael, CA
National Provider Identifier
1891916698
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFT35458
Practice address
1480 Lincoln Ave
#10
San Rafael, CA 94901
Phone
(415) 456-5596
Fax
(415) 479-7144
NPI assigned
May 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MFT35458 Primary

Addresses

Primary practice location

1480 Lincoln Ave
#10
San Rafael, CA 94901

Mailing address

1480 Lincoln Ave
#10
San Rafael, CA 94901
Phone (415) 456-5596

Other names 1

  • Mr. Unknown David Capitolo Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891916698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1480 LINCOLN AVE",
            "address_2": "#10",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "94901",
            "telephone_number": "415-456-5596",
            "fax_number": "415-479-7144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1480 LINCOLN AVE",
            "address_2": "#10",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "94901",
            "telephone_number": "415-456-5596",
            "fax_number": "415-479-7144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAPITOLO",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "MFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": "MFT35458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "UNKNOWN",
            "last_name": "CAPITOLO",
            "middle_name": "DAVID",
            "prefix": "MR.",
            "credential": "MFT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.