Provider Demographics
NPI:1457643462
Name:SEPULVEDA RUBIERA, LIDIA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:MARIA
Last Name:SEPULVEDA RUBIERA
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 1:2626 CAPITAL MEDICAL BLVD
Mailing Address - Street 2:ATTN: HOSPITALIST OFFICE
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4402
Mailing Address - Country:US
Mailing Address - Phone:850-325-5885
Mailing Address - Fax:
Practice Address - Street 1:2626 CAPITAL MEDICAL BOULEVARD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-325-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118939208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist