Healthcare Provider Details

I. General information

NPI: 1619192184
Provider Name (Legal Business Name): JULIO NELSON SEPULVEDA ACOSTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JULIO NELSON SEPULVEDA ACOSTA M.D.

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CALLE LLOVERAS COND CENTRO PLAZA SUITE 104
SAN JUAN PR
00909
US

IV. Provider business mailing address

H3 CALLE H
GUAYNABO PR
00966-1742
US

V. Phone/Fax

Practice location:
  • Phone: 787-625-1446
  • Fax:
Mailing address:
  • Phone: 787-313-5093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number017223
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number017223
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: