Provider Demographics
NPI:1710937180
Name:ROSARIO SEPULVEDA, CARLOS V (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:V
Last Name:ROSARIO SEPULVEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 SANTIAGO RIERA PALMER
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-834-3805
Mailing Address - Fax:787-265-7741
Practice Address - Street 1:169 SANTIAGO RIERA PALMER
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-3805
Practice Address - Fax:787-265-7741
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR007361207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0029458Medicare PIN
D32327Medicare UPIN