Healthcare Provider Details

I. General information

NPI: 1063488492
Provider Name (Legal Business Name): ARIEL SEPULVEDA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2006
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2681 CENTER COURT DR
WESTON FL
33332-1833
US

IV. Provider business mailing address

2681 CENTER COURT DR
WESTON FL
33332-1833
US

V. Phone/Fax

Practice location:
  • Phone: 954-529-3950
  • Fax: 954-389-0482
Mailing address:
  • Phone:
  • Fax: 954-389-0482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024187199
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3367602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: