Provider Demographics
NPI:1104362789
Name:SANCHEZ SEPULVEDA, JOHNNY F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:F
Last Name:SANCHEZ SEPULVEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHNNY
Other - Middle Name:F
Other - Last Name:SANCHEZ SEPULVEDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:13250 EMILY RD
Mailing Address - Street 2:APT 806
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5977
Mailing Address - Country:US
Mailing Address - Phone:914-482-2555
Mailing Address - Fax:
Practice Address - Street 1:13250 EMILY RD
Practice Address - Street 2:APT 806
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5977
Practice Address - Country:US
Practice Address - Phone:914-482-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16-687246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant