MEDICARE: MR. ARIEL SEPULVEDA CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	0024187199	VA
2	367500000X	Certified Registered Nurse Anesthetist	ARNP3367602	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063488492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARIEL SEPULVEDA CRNA

Provider Business Mailing Address
First Line	:	2681 CENTER COURT DR
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33332-1833
Country	:	US
Telephone Number	:
Fax Number	:	954-389-0482

Provider Business Practice Location Address
First Line	:	2681 CENTER COURT DR
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33332-1833
Country	:	US
Telephone Number	:	954-529-3950
Fax Number	:	954-389-0482

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2006
Last Update Date	:	08/30/2023

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