Individual
LOUIS SEPULVEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
33 SEWALL ST, PORTLAND, ME 04102-2603
(207) 828-2100
Mailing address
324 GANNETT DR STE 200, SOUTH PORTLAND, ME 04106-3266
(207) 482-7861
(207) 482-7898
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2389
ME
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225646474
—
ME
Enumeration date
07/14/2020
Last updated
07/26/2022
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