Provider Demographics
NPI:1346408317
Name:SAMUEL M SEPUYA MD. INC
Entity Type:Organization
Organization Name:SAMUEL M SEPUYA MD. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEPUYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, INC
Authorized Official - Phone:909-882-6900
Mailing Address - Street 1:1780 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4618
Mailing Address - Country:US
Mailing Address - Phone:909-882-6900
Mailing Address - Fax:909-882-6110
Practice Address - Street 1:1780 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4618
Practice Address - Country:US
Practice Address - Phone:909-882-6900
Practice Address - Fax:909-882-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35525207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty