MEDICARE: DR. RAYMOND A SEPULVEDA MD

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	207P00000X	Emergency Medicine Physician	5023	PR

General Provider Information

NPI Number	:	1396729935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND A SEPULVEDA MD

Provider Business Mailing Address
First Line	:	L4 CALLE CLAVEL
Second Line	:	URB. PARQUE DE SANTA MARIA
City	:	SAN JUAN
State	:	PR
Zip	:	00927-6735
Country	:	US
Telephone Number	:	787-292-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	L4 CALLE CLAVEL
Second Line	:	URB. PARQUE DE SANTA MARIA
City	:	SAN JUAN
State	:	PR
Zip	:	00927-6735
Country	:	US
Telephone Number	:	787-292-0600
Fax Number	:

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	05/31/2012

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