Provider Demographics
NPI:1598991671
Name:SEPULVADO, JENNIFER M (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:SEPULVADO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MADISON OAK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3913
Mailing Address - Country:US
Mailing Address - Phone:304-312-1890
Mailing Address - Fax:
Practice Address - Street 1:520 MADISON OAK DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3913
Practice Address - Country:US
Practice Address - Phone:304-312-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2381207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine