Healthcare Provider Details

I. General information

NPI: 1174272884
Provider Name (Legal Business Name): DANA SEPULVEDA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 WESTCLIFF DR STE 200
NEWPORT BEACH CA
92660-5552
US

IV. Provider business mailing address

PO BOX 15775
NEWPORT BEACH CA
92659-5775
US

V. Phone/Fax

Practice location:
  • Phone: 714-845-5900
  • Fax: 714-845-5920
Mailing address:
  • Phone: 657-241-3600
  • Fax: 657-241-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0997103-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95031204
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95376555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: