Healthcare Provider Details

I. General information

NPI: 1730248303
Provider Name (Legal Business Name): MRS. SONIA L SEPULVEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#628 CALLE PEDRO VELAZQUEZ DIAZ EDIFICIO AURORA B1
PENUELAS PR
00624
US

IV. Provider business mailing address

PO BOX 490
PENUELAS PR
00624
US

V. Phone/Fax

Practice location:
  • Phone: 787-836-2178
  • Fax: 787-836-2255
Mailing address:
  • Phone: 787-836-2178
  • Fax: 787-826-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number975
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number347
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: