Individual ProviderLouis SepulvedaPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address33 Sewall St, Portland, ME 04102-2603(207) 828-2100(207) 482-7861PECOS EnrollmentBased on the most recent information from CMS, provider Louis Sepulveda is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 2:35 PM.Profile DetailsProvider ID1225646474Provider TypeIndividualFull NameSepulveda, LouisGenderMaleSole ProprietorNoEnumeration Date7/14/2020Last Updated7/26/2022Contact InformationPractice LocationPractice Address33 Sewall St, Portland, ME 04102-2603Phone(207) 828-2100FaxUnlisted FaxMailing LocationMailing Address324 Gannett Dr Ste 200, South Portland, ME 04106-3266Phone(207) 482-7861Fax(207) 482-7898Provider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA2389MaineCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID1225646474DescriptionMedicaidIssuerUnlistedMaine