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General NPI Number Information
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NPI Number | 1326518085
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Entity Type | Individual
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Provider Name | ROEL SEPULVEDA PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 4435 E CHANDLER BLVD STE 200
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City | PHOENIX
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State | AZ
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Zip | 85048-7651
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Country | US
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Telephone | 833-351-8255
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Fax |
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Provider Business Mailing Address
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Address Line | 941 YORK DR STE 205
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City | DESOTO
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State | TX
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Zip | 75115-2066
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Country | US
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Telephone | 972-283-6286
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Fax | 214-217-4819
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 262597
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 64096
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP139255
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 9328
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 407779
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 277001861
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License Number State | IL
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