Healthcare Provider Details

I. General information

NPI: 1710282462
Provider Name (Legal Business Name): BARBARA MACIEL SEPULVEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 E BALL RD STE 200
ANAHEIM CA
92806-5157
US

IV. Provider business mailing address

405 W 5TH ST STE 202A
SANTA ANA CA
92701-4522
US

V. Phone/Fax

Practice location:
  • Phone: 714-517-6300
  • Fax:
Mailing address:
  • Phone: 714-834-3747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: