Individual provider Active NPI

Isabel Cristina Sepulveda, DDS

  • General Practice Dentistry
  • Miramar, FL
National Provider Identifier
1790111763
Registry record updated Sep 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
20070 Issued in FL
Practice address
4162 SW 158TH Ave
Miramar, FL 33027-4835
Phone
(917) 519-9585
NPI assigned
Sep 22, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 20070 FL Primary

Addresses

Primary practice location

4162 SW 158TH Ave
Miramar, FL 33027-4835

Mailing address

4162 SW 158TH Ave
Miramar, FL 33027-4835
Phone (917) 519-9585

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170222000020 FL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 2466736327

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
20070FLMDMental Health Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379808000000",
    "number": "1790111763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4162 SW 158TH AVE",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330274835",
            "telephone_number": "917-519-9585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4162 SW 158TH AVE",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330274835",
            "telephone_number": "917-519-9585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEPULVEDA",
        "first_name": "ISABEL",
        "middle_name": "CRISTINA",
        "name_prefix": "Mrs.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-22",
        "last_updated": "2013-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "20070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miramar, FL

Sources for this page

Verify at the official NPI Registry.