Basic Information
| Provider Information | |||||||||
| NPI: | 1346408317 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAMUEL M SEPUYA MD. INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1780 E HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924044618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098826900 | ||||||||
| FaxNumber: | 9098826110 | ||||||||
| Practice Location | |||||||||
| Address1: | 1780 E HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924044618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098826900 | ||||||||
| FaxNumber: | 9098826110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2008 | ||||||||
| LastUpdateDate: | 08/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | SEPUYA | ||||||||
| AuthorizedOfficialFirstName: | SAMUEL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9098826900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD, INC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | A35525 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.