Provider Demographics
NPI:1548539026
Name:SEPULVEDA, NYDIA L (RN)
Entity type:Individual
Prefix:MISS
First Name:NYDIA
Middle Name:L
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601-0615
Mailing Address - Country:US
Mailing Address - Phone:787-382-5142
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL SIQUIATRIA FORENSE- AVE. TITO CASTRO
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732-7321
Practice Address - Country:US
Practice Address - Phone:787-382-5142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10813163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse