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General NPI Number Information
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NPI Number | 1225590821
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Entity Type | Individual
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Provider Name | JOSE ALFREDO RIVERA SEPULVEDA MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 405 S COLLEGE ST
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City | STATESBORO
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State | GA
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Zip | 30458-5409
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Country | US
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Telephone | 478-621-2072
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3594
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City | MAYAGUEZ
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State | PR
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Zip | 00681-3594
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Country | US
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Telephone | 939-940-6670
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35269-R
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 94290
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License Number State | GA
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