Active NPI
Diego Javier Sepulveda Rosado
- Student in an Organized Health Care Education/Training Program
- San Juan, PR
National Provider Identifier
1306528096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 2658
- Practice address
- 100 Grand Paseo Blvd
San Juan, PR 00926-5905 - Phone
- (787) 283-2555
- NPI assigned
- Aug 2, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 3041 | PR | |
| Student in an Organized Health Care Education/Training Program | 390200000X | 2658 | PR | Primary |
Addresses
Primary practice location
100 Grand Paseo Blvd
San Juan, PR 00926-5905
Mailing address
3950 Carr 176 Apt 30
San Juan, PR 00926-6611
Phone (787) 515-0694
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2658 | PR | MD | General Practice Dentistry |
| 3041 | PR | MD | Other Specialist/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709856000000",
"number": "1306528096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3950 CARR 176 APT 30",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009266611",
"telephone_number": "787-515-0694"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 GRAND PASEO BLVD",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009265905",
"telephone_number": "787-283-2555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEPULVEDA ROSADO",
"first_name": "DIEGO",
"middle_name": "JAVIER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-02",
"last_updated": "2024-03-08",
"certification_date": "2024-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "PR",
"license": "3041",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "PR",
"license": "2658",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Juan, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.