1750693719 NPI number — DR. ANDREA VICTORIA RIVERA-SEPULVEDA M.D.

Table of content: DR. ANDREA VICTORIA RIVERA-SEPULVEDA M.D. (NPI 1750693719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750693719 NPI number — DR. ANDREA VICTORIA RIVERA-SEPULVEDA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA-SEPULVEDA
Provider First Name:
ANDREA
Provider Middle Name:
VICTORIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1750693719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1402 SOUTH GRAND BLVD, ROOM M260
Provider Second Line Business Mailing Address:
SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE, GME OFFICE
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-602-8372
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13535 NEMOURS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32827-7402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-602-8372
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  2015019910 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 20600 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0204X , with the licence number: 139034 , registered in the state of FL ; 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