{
"Npi": {
"NPI": "1780253344",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "RESTREPO",
"FirstName": "MICHAEL",
"MiddleName": "LUIS",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "MS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "761 S LOS ROBLES AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91106-3740",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "949-244-8769",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1500 DUARTE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DUARTE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91010-3012",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "626-218-0584",
"PracticeLocationAddressFaxNumber": "626-218-5495",
"EnumerationDate": "06/18/2021",
"LastUpdateDate": "06/18/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "170300000X",
"TaxonomyName": "Genetic Counselor (M.S.)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}