MEDICARE: MRS. DANA SEPULVEDA FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	95376555	CA
2	363LF0000X	Family Nurse Practitioner	APN.0997103-NP	CO
3	363LF0000X	Family Nurse Practitioner	NP95031204	CA

General Provider Information

NPI Number	:	1174272884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA SEPULVEDA FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 15775
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92659-5775
Country	:	US
Telephone Number	:	657-241-3600
Fax Number	:	657-241-7708

Provider Business Practice Location Address
First Line	:	2001 WESTCLIFF DR STE 200
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5552
Country	:	US
Telephone Number	:	714-845-5900
Fax Number	:	714-845-5920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2022
Last Update Date	:	09/18/2025

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