Provider Demographics
NPI:1710282462
Name:SEPULVEDA, BARBARA MACIEL
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:MACIEL
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 N CHAFFEY CT
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-1642
Mailing Address - Country:US
Mailing Address - Phone:626-675-1021
Mailing Address - Fax:
Practice Address - Street 1:2200 E ROUTE 66 STE 100
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4662
Practice Address - Country:US
Practice Address - Phone:626-859-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner