Provider Demographics
NPI:1215226527
Name:SEPULVEDA, CLAUDIA G
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:G
Last Name:SEPULVEDA
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 1:1720 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19107 SPRINGPORT DR
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-3046
Practice Address - Country:US
Practice Address - Phone:562-922-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2019-08-13
Deactivation Date:2018-03-20
Deactivation Code:
Reactivation Date:2019-08-12
Provider Licenses
StateLicense IDTaxonomies
CAVN206941323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility