Provider Demographics
NPI:1710486501
Name:SEPA 2, LLC
Entity Type:Organization
Organization Name:SEPA 2, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-596-4288
Mailing Address - Street 1:10621 N KENDALL DR STE 211
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1530
Mailing Address - Country:US
Mailing Address - Phone:305-596-4288
Mailing Address - Fax:305-596-6378
Practice Address - Street 1:10621 N KENDALL DR STE 211
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1530
Practice Address - Country:US
Practice Address - Phone:305-596-4288
Practice Address - Fax:305-596-6378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization