1013989987 NPI number — DR DOMINGO SEPULVEDA CSP

Table of content: MARISSA MEISLER (NPI 1124281183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013989987 NPI number — DR DOMINGO SEPULVEDA CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR DOMINGO SEPULVEDA CSP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013989987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6419
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00776-6419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-743-3003
Provider Business Mailing Address Fax Number:
787-743-9290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE LUIS MANOR MARIN HOSPITAL HIMA
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-743-3003
Provider Business Practice Location Address Fax Number:
787-743-9290
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SEPULVEDA
Authorized Official First Name:
DOMINGO
Authorized Official Middle Name:
Authorized Official Title or Position:
PEDIATRICTAIN
Authorized Official Telephone Number:
787-743-3003

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  4295 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com