MEDICARE: PREVENTATIVE HEALTHCARE SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	104100000X	Social Worker
3	103T00000X	Psychologist
4	363LF0000X	Family Nurse Practitioner

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D100262848	OTHER	CT	MEDICARE PTAN

General Provider Information

NPI Number	:	1528434115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENTATIVE HEALTHCARE SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	80 ELM ST
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06604-4115
Country	:	US
Telephone Number	:	203-870-8008
Fax Number	:	203-330-8007

Provider Business Practice Location Address
First Line	:	80 ELM ST
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06604-4115
Country	:	US
Telephone Number	:	203-870-8008
Fax Number	:	203-330-8007

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NOEL H SEPULVEDA
Credential	:	D.C.
Telephone Number	:	203-870-8008

Provider Enumeration Date	:	08/18/2015
Last Update Date	:	03/26/2026

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Directions to “PREVENTATIVE HEALTHCARE SOLUTIONS LLC ” Practice Location

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