Provider Demographics
NPI:1013177799
Name:SEPULVEDA, RICARDO NATHANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:NATHANIEL
Last Name:SEPULVEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICARDO
Other - Middle Name:NATHANIEL
Other - Last Name:SEPULVEDA-FLORES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8002 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1865
Mailing Address - Country:US
Mailing Address - Phone:210-348-8788
Mailing Address - Fax:210-348-8768
Practice Address - Street 1:8002 WEST AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1865
Practice Address - Country:US
Practice Address - Phone:210-348-8788
Practice Address - Fax:210-348-8768
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4076207WX0107X, 207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX410779ZKS7Medicare PIN