Basic Information
| Provider Information | |||||||||
| NPI: | 1043818321 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEPULVEDA | ||||||||
| FirstName: | JOSEAN | ||||||||
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| Credential: | PHYSICIAN ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | CALLE C-G-10 | ||||||||
| Address2: | URB. EL ROSARIO | ||||||||
| City: | VEGA BAJA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006930000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879750404 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 AVE LUIS MUNOZ MARIN | ||||||||
| Address2: | |||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007256184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876531750 | ||||||||
| FaxNumber: | 7879614562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2020 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 15971I | PR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | 23019 | PR | Y | Allopathic & Osteopathic Physicians | General Practice | 363A00000X | 792-PA | PR | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.