Provider Demographics
NPI:1396729935
Name:SEPULVEDA, RAYMOND A (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:SEPULVEDA
Suffix:
Gender:M
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:L4 CALLE CLAVEL
Mailing Address - Street 2:URB. PARQUE DE SANTA MARIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6735
Mailing Address - Country:US
Mailing Address - Phone:787-292-0600
Mailing Address - Fax:
Practice Address - Street 1:L4 CALLE CLAVEL
Practice Address - Street 2:URB. PARQUE DE SANTA MARIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6735
Practice Address - Country:US
Practice Address - Phone:787-292-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5023207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR99245Medicare ID - Type Unspecified
PRE51175Medicare UPIN