Healthcare Provider Details

I. General information

NPI: 1245657790
Provider Name (Legal Business Name): OMAYRA SEPULVEDA RODRIGUEZ I M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2014
Last Update Date: 03/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 AVE HOSTOS SUITE 7
MAYAGUEZ PR
00682-1560
US

IV. Provider business mailing address

410 AVE HOSTOS SUITE 7
MAYAGUEZ PR
00682-1560
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0663
  • Fax: 787-831-3714
Mailing address:
  • Phone: 787-833-0663
  • Fax: 787-831-3714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9429
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: