Provider Demographics
NPI:1376559005
Name:SEPULVEDA, GLADYS E (MD)
Entity Type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:E
Last Name:SEPULVEDA
Suffix:
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:PO BOX 7949
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7949
Mailing Address - Country:US
Mailing Address - Phone:787-844-1988
Mailing Address - Fax:
Practice Address - Street 1:ANEXO #6
Practice Address - Street 2:HOSPITAL ONCOLOGICO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00763
Practice Address - Country:US
Practice Address - Phone:787-844-1988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8590207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29844OtherTRIPLE S
PR29844OtherTRIPLE S