Provider Demographics
NPI:1003342494
Name:SEPULVEDA GARCIA, LUIS RUBEN
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:RUBEN
Last Name:SEPULVEDA GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PALMARES DE MONTEVERDE
Mailing Address - Street 2:94 RAMAL 842 APT 55
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-674-9500
Mailing Address - Fax:803-721-8003
Practice Address - Street 1:RYDER MEMORIAL HOSPITAL
Practice Address - Street 2:#355 CALLE FONT MARTELO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-0768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22687207R00000X, 207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism