Healthcare Provider Details

I. General information

NPI: 1730393752
Provider Name (Legal Business Name): JANET MARIE SEPULVEDA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CALLE GUARIONEX HATO REY
SAN JUAN PR
00918-4431
US

IV. Provider business mailing address

501 CALLE MARIEN COLINAS DE BAYOAN
BAYAMON PR
00957-3780
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-7695
  • Fax:
Mailing address:
  • Phone: 787-279-3572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2700
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: