Basic Information
| Provider Information | |||||||||
| NPI: | 1457643462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEPULVEDA RUBIERA | ||||||||
| FirstName: | LIDIA | ||||||||
| MiddleName: | MARIA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2626 CAPITAL MEDICAL BLVD | ||||||||
| Address2: | ATTN: HOSPITALIST OFFICE | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8503255885 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2626 CAPITAL MEDICAL BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8503255885 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2011 | ||||||||
| LastUpdateDate: | 10/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME118939 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.