Provider Demographics
NPI:1063488492
Name:SEPULVEDA, ARIEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ARIEL
Middle Name:
Last Name:SEPULVEDA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2681 CENTER COURT DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-1833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:954-389-0482
Practice Address - Street 1:2681 CENTER COURT DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33332-1833
Practice Address - Country:US
Practice Address - Phone:954-529-3950
Practice Address - Fax:954-389-0482
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187199367500000X
FLARNP3367602367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258078100Medicaid
FLG2568XMedicare ID - Type Unspecified
FL258078100Medicaid