Provider Demographics
NPI:1245657790
Name:SEPULVEDA RODRIGUEZ, OMAYRA I (MD)
Entity type:Individual
Prefix:MRS
First Name:OMAYRA
Middle Name:
Last Name:SEPULVEDA RODRIGUEZ
Suffix:I
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 1:410 AVE HOSTOS
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-1560
Mailing Address - Country:US
Mailing Address - Phone:787-833-0663
Mailing Address - Fax:787-831-3714
Practice Address - Street 1:410 AVE HOSTOS
Practice Address - Street 2:SUITE 7
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1560
Practice Address - Country:US
Practice Address - Phone:787-833-0663
Practice Address - Fax:787-831-3714
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-22
Last Update Date:2014-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR94291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical