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General NPI Number Information
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NPI Number | 1699963983
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Entity Type | Individual
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Provider Name | WANDA SEPULVEDA OD
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Gender | Female
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 1498 FD ROOSEVELT STE 16
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City | GUAYNABO
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State | PR
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Zip | 00968-2735
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Country | US
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Telephone | 787-783-1085
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Fax |
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Provider Business Mailing Address
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Address Line | 215 CALLE MANUEL ROSSY BALDRICH
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City | SAN JUAN
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State | PR
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Zip | 00918-4311
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Country | US
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Telephone | 787-998-0317
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 161
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License Number State | PR
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