Provider Demographics
NPI:1013636240
Name:SEPULVEDA, CHRISTOPHER RAY JR
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:RAY
Last Name:SEPULVEDA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 INVERNESS DR
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-6492
Mailing Address - Country:US
Mailing Address - Phone:915-238-1679
Mailing Address - Fax:
Practice Address - Street 1:337 INVERNESS DR
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-6492
Practice Address - Country:US
Practice Address - Phone:915-238-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician