Provider Demographics
NPI:1649558719
Name:SEPULVEDA, VERONICA (MD)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:SEPULVEDA
Suffix:
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:URB MONTEHIEDRA, 107 CALLE PITIRRE
Mailing Address - Street 2:MONTEHIEDRA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-923-3111
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 191079
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919-1079
Practice Address - Country:US
Practice Address - Phone:787-474-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-23
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18742208000000X, 2080P0204X
KY48877208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201393240Medicaid
KY7100419360Medicaid
KY7100419360Medicaid