Healthcare Provider Details

I. General information

NPI: 1578543641
Provider Name (Legal Business Name): MARIA M SEPULVEDA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA 65 INFANTERIA KM 3.4 BARRIO SABINA LLANA
SAN JUAN PR
00924
US

IV. Provider business mailing address

429 CALLE CHEVERE
SAN JUAN PR
00923-2622
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-7676
  • Fax: 787-764-9904
Mailing address:
  • Phone: 767-767-7676
  • Fax: 767-764-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number015069
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: