Provider Demographics
NPI:1194252106
Name:SEPULVEDA, JOSE CARLOS (DO)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:CARLOS
Last Name:SEPULVEDA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-1271
Mailing Address - Country:US
Mailing Address - Phone:254-537-6160
Mailing Address - Fax:254-755-6695
Practice Address - Street 1:2100 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-1271
Practice Address - Country:US
Practice Address - Phone:254-537-6160
Practice Address - Fax:254-755-6695
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9139207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine