Provider Demographics
NPI:1497726210
Name:SEPULVEDA, JOSE
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:SEPULVEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:F22 CALLE 8
Mailing Address - Street 2:TINTILLO GARDENS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1607
Mailing Address - Country:US
Mailing Address - Phone:787-725-7241
Mailing Address - Fax:
Practice Address - Street 1:F22 CALLE 8
Practice Address - Street 2:TINTILLO GARDENS
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1607
Practice Address - Country:US
Practice Address - Phone:787-725-7241
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
21248Medicare ID - Type Unspecified
H75686Medicare UPIN