Provider Demographics
NPI:1487463444
Name:CAPETILLO, ALEXANDRIA
Entity type:Individual
Prefix:MS
First Name:ALEXANDRIA
Middle Name:
Last Name:CAPETILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 N PALM AVE APT A
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3882
Mailing Address - Country:US
Mailing Address - Phone:909-365-8273
Mailing Address - Fax:
Practice Address - Street 1:572 NORTH ARROWHEAD AVENUE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401
Practice Address - Country:US
Practice Address - Phone:909-470-1456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-04
Last Update Date:2025-02-25
Deactivation Date:2025-01-06
Deactivation Code:
Reactivation Date:2025-02-25
Provider Licenses
StateLicense IDTaxonomies
CA17090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health