Provider Demographics
NPI:1558611459
Name:SEPULVEDA-ACOSTA, RAFAEL JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:JOSE
Last Name:SEPULVEDA-ACOSTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAFAEL
Other - Middle Name:JOSE
Other - Last Name:SEPULVEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:369 PERKINS ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6826
Mailing Address - Country:US
Mailing Address - Phone:707-776-6154
Mailing Address - Fax:707-800-0076
Practice Address - Street 1:369 PERKINS ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6826
Practice Address - Country:US
Practice Address - Phone:707-776-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA150301207R00000X, 207RB0002X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine