Provider Demographics
NPI:1457879967
Name:SAQUIPULLA, WALTER MAURICIO
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:MAURICIO
Last Name:SAQUIPULLA
Suffix:
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 1:354 SAW MILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4005
Mailing Address - Country:US
Mailing Address - Phone:203-896-7000
Mailing Address - Fax:203-399-0180
Practice Address - Street 1:354 SAW MILL RD
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4005
Practice Address - Country:US
Practice Address - Phone:203-896-7000
Practice Address - Fax:203-399-0180
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant