Healthcare Provider Details

I. General information

NPI: 1033068499
Provider Name (Legal Business Name): FELICIA ANN SEPULVEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1515 E SANGER ST
HOBBS NM
88240-4713
US

IV. Provider business mailing address

1500 S AVENUE K
PORTALES NM
88130-7400
US

V. Phone/Fax

Practice location:
  • Phone: 575-433-2500
  • Fax:
Mailing address:
  • Phone: 575-562-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberSWB-2025-1256
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: