Individual
JACKELINE LUCIA SEPULVEDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2946 E BANNER GATEWAY DRIVE, GILBERT, AZ 85234-2165
(480) 256-6444
(480) 256-4734
Mailing address
2940 E BANNER GATEWAY DRIVE, SUITE 450, GILBERT, AZ 85234-2165
(480) 256-6444
(480) 256-4734
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9903
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/03/2022
Last updated
02/14/2025
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