Provider Demographics
NPI:1366519167
Name:SEPULVEDA, JAIME LUIS (MD, FACOG, FACS)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:LUIS
Last Name:SEPULVEDA
Suffix:
Gender:M
Credentials:MD, FACOG, FACS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6200 SUNSET DR
Mailing Address - Street 2:SUITE 504
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4828
Mailing Address - Country:US
Mailing Address - Phone:305-669-6167
Mailing Address - Fax:305-669-6815
Practice Address - Street 1:6200 SUNSET DR
Practice Address - Street 2:SUITE 504
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4828
Practice Address - Country:US
Practice Address - Phone:305-669-6167
Practice Address - Fax:305-669-6815
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2013-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME57803207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE59297Medicare UPIN
FL11309-ZMedicare ID - Type Unspecified