Healthcare Provider Details

I. General information

NPI: 1386191070
Provider Name (Legal Business Name): CAROLINA RESTREPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3787 S VERMONT AVE
LOS ANGELES CA
90007-4203
US

IV. Provider business mailing address

3031 S VERMONT AVE
LOS ANGELES CA
90007-3033
US

V. Phone/Fax

Practice location:
  • Phone: 323-766-2345
  • Fax:
Mailing address:
  • Phone: 323-373-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number77929
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: