Provider Demographics
NPI:1811966591
Name:PIETRI SEPULVEDA, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:PIETRI SEPULVEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:PIETRI SEPULVEDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:CALLE TAINO NUM 645
Mailing Address - Street 2:URB VILLA TABAIBA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-1317
Mailing Address - Country:US
Mailing Address - Phone:787-548-9922
Mailing Address - Fax:787-737-0244
Practice Address - Street 1:CARR 941
Practice Address - Street 2:SALIDA BARRIO JAGUAS
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-4866
Practice Address - Fax:787-737-0244
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16027208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice