Individual
MS. ANDY SEPULVEDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
4515 PORTOLA PKWY, IRVINE, CA 92620-2200
(949) 936-7244
Mailing address
1797 N WILLOW WOODS DR UNIT C, ANAHEIM, CA 92807-1459
(714) 404-7916
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020002011
BOC
CA
Enumeration date
09/16/2022
Last updated
09/16/2022
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