MEDICARE: ERNESTO JOSUE SEPULVEDA

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	183700000X	Pharmacy Technician	11046	PR

General Provider Information

NPI Number	:	1588341960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNESTO JOSUE SEPULVEDA

Provider Business Mailing Address
First Line	:	1008 AVE AMERICO MIRANDA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-2842
Country	:	US
Telephone Number	:	787-274-8326
Fax Number	:

Provider Business Practice Location Address
First Line	:	1008 AVE AMERICO MIRANDA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-2842
Country	:	US
Telephone Number	:	787-274-8326
Fax Number	:

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

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	06/28/2023

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Directions to “ ERNESTO JOSUE SEPULVEDA ” Practice Location

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