Provider Demographics
NPI:1376504993
Name:SEPULVEDA-PAGAN, NYDIA I II (MD)
Entity Type:Individual
Prefix:DR
First Name:NYDIA
Middle Name:I
Last Name:SEPULVEDA-PAGAN
Suffix:II
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR. 135 KM. 70.2
Mailing Address - Street 2:BO. YAHUECAS
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601-9711
Mailing Address - Country:US
Mailing Address - Phone:787-829-0824
Mailing Address - Fax:787-597-6372
Practice Address - Street 1:CARR 135 KM 70.2
Practice Address - Street 2:BO. YAHUECAS
Practice Address - City:ADJUNTAS
Practice Address - State:PR
Practice Address - Zip Code:00601-9711
Practice Address - Country:US
Practice Address - Phone:787-829-0824
Practice Address - Fax:787-597-6372
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI21364Medicare UPIN