Provider Demographics
NPI:1891976965
Name:SEPULVEDA, ALFONSO DIAZ (RN, BSN, PHN)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:DIAZ
Last Name:SEPULVEDA
Suffix:
Gender:M
Credentials:RN, BSN, PHN
Other - Prefix:
Other - First Name:AL
Other - Middle Name:DIAZ
Other - Last Name:SEPULVEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1800 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-3302
Mailing Address - Country:US
Mailing Address - Phone:661-868-0502
Mailing Address - Fax:661-868-0218
Practice Address - Street 1:1800 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-3302
Practice Address - Country:US
Practice Address - Phone:661-868-0502
Practice Address - Fax:661-868-0218
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548397163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health