Healthcare Provider Details

I. General information

NPI: 1902240344
Provider Name (Legal Business Name): JULIAN RESTREPO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2013
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ICON
FOOTHILL RANCH CA
92610-3000
US

IV. Provider business mailing address

PO BOX 70180
RIVERSIDE CA
92513-0180
US

V. Phone/Fax

Practice location:
  • Phone: 949-900-7136
  • Fax: 949-900-7302
Mailing address:
  • Phone: 951-354-3216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA136382
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA136382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: