Healthcare Provider Details

I. General information

NPI: 1255624995
Provider Name (Legal Business Name): ALEXIS SEPULVEDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B47 URB CABRERA
UTUADO PR
00641-2209
US

IV. Provider business mailing address

B47 URBANIZACION CABRERA
UTUADO PR
00641-2209
US

V. Phone/Fax

Practice location:
  • Phone: 787-372-9639
  • Fax: 787-385-7764
Mailing address:
  • Phone: 787-372-9639
  • Fax: 787-369-7990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number7122521
License Number StatePR

VIII. Authorized Official

Name: ALEXIS SEPULVEDA
Title or Position: DIRECTOR
Credential:
Phone: 787-372-9639