Healthcare Provider Details

I. General information

NPI: 1407840325
Provider Name (Legal Business Name): CARLOS E SEPULVEDA JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 22 15 # 37 SABANA GARDENS
CAROLINA PR
00983
US

IV. Provider business mailing address

URB. SABANA GARDENS CALLE 22 15 # 37
CAROLINA PR
00983
US

V. Phone/Fax

Practice location:
  • Phone: 787-361-9626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00085
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: