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General NPI Number Information
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NPI Number | 1689079444
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Entity Type | Individual
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Provider Name | DAVID AARON SEPULVEDA LMFT
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Gender | Male
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 4010 MERRILL AVE STE C-2
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City | RIVERSIDE
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State | CA
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Zip | 92506-2216
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Country | US
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Telephone | 951-384-0506
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Fax | 951-783-4016
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Provider Business Mailing Address
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Address Line | 2781 W RAMSEY ST STE 1
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City | BANNING
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State | CA
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Zip | 92220-3700
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Country | US
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Telephone | 951-849-3896
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Fax | 951-683-4239
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT110782
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License Number State | CA
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