Individual
LIBANESA SEPULVEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1515 SOUTHERN BLVD, BRONX, NY 10460-5980
(718) 589-3400
Mailing address
1775 CLAY AVE APT 6B, BRONX, NY 10457-7207
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
0246411
NY
Other
Enumeration date
10/25/2012
Last updated
10/25/2012
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