Provider Demographics
NPI:1699963983
Name:SEPULVEDA, WANDA (OD)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CALLE MANUEL ROSSY
Mailing Address - Street 2:BALDRICH
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4311
Mailing Address - Country:US
Mailing Address - Phone:787-998-0317
Mailing Address - Fax:
Practice Address - Street 1:1498 FD ROOSEVELT STE 16
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-2735
Practice Address - Country:US
Practice Address - Phone:787-783-1085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR161152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist