MEDICARE: NANCY SEPULVEDA

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1770731705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY SEPULVEDA

Provider Business Mailing Address
First Line	:	255 N SAN GABRIEL BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3429
Country	:	US
Telephone Number	:	626-696-1270
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 N SAN GABRIEL BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3429
Country	:	US
Telephone Number	:	626-696-1270
Fax Number	:

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

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	05/07/2013

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Directions to “ NANCY SEPULVEDA ” Practice Location

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