Basic Information
| Provider Information | |||||||||
| NPI: | 1659040855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEPULVEDA | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | TERESA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 53 DISTANT STAR | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926188817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492411100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20342 FLANAGAN ROAD | ||||||||
| Address2: | |||||||||
| City: | TRABUCO CANYON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185828832 | ||||||||
| FaxNumber: | 8185828836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2021 | ||||||||
| LastUpdateDate: | 09/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374700000X | Y | Nursing Service Related Providers | Technician |
No ID Information.