Provider Demographics
NPI:1891062238
Name:SEPULVEDA RAMOS, MELISSA (MD)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:SEPULVEDA RAMOS
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 1:81 ARCH APT203
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103
Mailing Address - Country:US
Mailing Address - Phone:787-503-6368
Mailing Address - Fax:
Practice Address - Street 1:300 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3509
Practice Address - Country:US
Practice Address - Phone:787-765-7320
Practice Address - Fax:787-281-5104
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18618207ZP0102X
CT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR18618OtherUNIVERSITY DISTRICT HOSPITAL