Provider Demographics
NPI:1871689059
Name:SEPULVEDA, KARLA A (MD)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:A
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15655 CYPRESSWOODS MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1471
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:15655 CYPRESSWOODS MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1471
Practice Address - Country:US
Practice Address - Phone:713-442-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL38162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172937801Medicaid
TX172937803Medicaid
TX172937802Medicaid
TX172937804Medicaid
TX172937804Medicaid
TX172937802Medicaid
TX8D4923Medicare PIN
TXP00702000Medicare PIN
TXP00738135Medicare PIN
TX8D4922Medicare PIN
TX8D4929Medicare PIN