Healthcare Provider Details

I. General information

NPI: 1174582845
Provider Name (Legal Business Name): MIGUEL SANTIAGO RESTREPO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL CARDIOLOGY
MADERA CA
93636-8761
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL CARDIOLOGY
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-6257
  • Fax: 559-353-5455
Mailing address:
  • Phone: 559-353-6257
  • Fax: 559-353-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA87656
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number39660
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA87656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: