=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902533094
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH ESTHER SEPULVEDA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2022
-----------------------------------------------------
Last Update Date | 10/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 112 KM 1.2 BO PUEBLO
-----------------------------------------------------
City | ISABELA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-319-5621
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 CALLE LOS CIPRESES
-----------------------------------------------------
City | MOCA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00676-5057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-462-2514
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TF0000X
-----------------------------------------------------
Taxonomy Name | Family Psychologist
-----------------------------------------------------
License Number | 6579
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------