Provider Demographics
NPI:1174172506
Name:JOSEPH M CAPORUSSO DPM PA
Entity type:Organization
Organization Name:JOSEPH M CAPORUSSO DPM PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-971-9107
Mailing Address - Street 1:812 LINDBERG AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2930
Mailing Address - Country:US
Mailing Address - Phone:956-971-9107
Mailing Address - Fax:956-971-9109
Practice Address - Street 1:812 LINDBERG AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2930
Practice Address - Country:US
Practice Address - Phone:956-971-9107
Practice Address - Fax:956-971-9109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPLETE FAMILY FOOT CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-09
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157919501Medicaid
TX018805401Medicaid