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NPI Code Detail

MEDICARE: ROEL SEPULVEDA PMHNP-BC

MEDICARE: ROEL SEPULVEDA PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner262597AZ
2363LP0808XPsychiatric/Mental Health Nurse Practitioner64096NM
3363LP0808XPsychiatric/Mental Health Nurse PractitionerAP139255TX
4363LP0808XPsychiatric/Mental Health Nurse Practitioner9328MN
5363LP0808XPsychiatric/Mental Health Nurse Practitioner407779NY
6363LP0808XPsychiatric/Mental Health Nurse Practitioner277001861IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326518085
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROEL SEPULVEDA PMHNP-BC
Provider Business Mailing Address
First Line : 941 YORK DR STE 205
Second Line :
City : DESOTO
State : TX
Zip : 75115-2066
Country : US
Telephone Number : 972-283-6286
Fax Number : 214-217-4819
Provider Business Practice Location Address
First Line : 4435 E CHANDLER BLVD STE 200
Second Line :
City : PHOENIX
State : AZ
Zip : 85048-7651
Country : US
Telephone Number : 833-351-8255
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2018
Last Update Date : 12/02/2025

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