Healthcare Provider Details

I. General information

NPI: 1912114299
Provider Name (Legal Business Name): CARMEN TERESA SEPULVEDA LABOY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 AVE HOSTOS SUITE 7
MAYAGUEZ PR
00682-1522
US

IV. Provider business mailing address

PO BOX 1792
SAN GERMAN PR
00683-1792
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0663
  • Fax: 787-832-2325
Mailing address:
  • Phone: 787-892-0986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13326
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: