Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | ME57803 | FL |
NPI | 1366519167 |
---|---|
Provider Name | Dr. Jaime Luis Sepulveda |
First Address | South Miami, FL 33143-4828 |
Second Address | South Miami, FL 33143-4828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E59297 | (02) | FL |