Individual
JOSE ALFREDO RIVERA SEPULVEDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
405 S COLLEGE ST, STATESBORO, GA 30458-5409
(478) 621-2072
Mailing address
PO BOX 3594, MAYAGUEZ, PR 00681-3594
(939) 940-6670
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35269-R
PR
207R00000X
Internal Medicine Physician
Primary
94290
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2019
Last updated
12/28/2023
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