Healthcare Provider Details

I. General information

NPI: 1992992887
Provider Name (Legal Business Name): BIBIANA RESTREPO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST # 334
BOSTON MA
02111-1552
US

IV. Provider business mailing address

2825 50TH ST
SACRAMENTO CA
95817-2310
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-8080
  • Fax:
Mailing address:
  • Phone: 916-703-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME102030
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number258857
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number151456
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberBP10021650
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME102030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: