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Contact Information

LOUIS SEPULVEDA
33 SEWALL ST
PORTLAND, ME04102-2603
 Phone: 207-828-2100
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Student in an Organized Health Care Education/Training Program

390200000X
Indicates primary specialty

NPI Profile & details for LOUIS SEPULVEDA · (Male)

NPI Number 1225646474
Status Active
Credentials
Entity Individual
Enumeration date 07/14/2020
Last updated 07/26/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • ME License # PA2389
  • ME Medicaid 1225646474
Hospital affiliation(s)
  • ST CHARLES HOSPITAL - (Acute Care)
    200 BELLE TERRE ROAD
    PORT JEFFERSON, NY 11777
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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