Provider Demographics
NPI:1760644710
Name:SEPULVEDA, PATRICIA LOWE (M D)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LOWE
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:LOWE
Other - Last Name:REIMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:20750 N JOHN WAYNE PKWY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-5882
Mailing Address - Country:US
Mailing Address - Phone:520-233-2465
Mailing Address - Fax:
Practice Address - Street 1:20750 N JOHN WAYNE PKWY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-5882
Practice Address - Country:US
Practice Address - Phone:152-023-3246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45209207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ180063OtherPTAN