MEDICARE: DR. HUMBERTO RESTREPO OMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	2027	NV

General Provider Information

NPI Number	:	1649811878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUMBERTO RESTREPO OMD

Provider Business Mailing Address
First Line	:	7487 PALERMO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-5156
Country	:	US
Telephone Number	:	702-682-3767
Fax Number	:

Provider Business Practice Location Address
First Line	:	5594 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-3610
Country	:	US
Telephone Number	:	702-763-1168
Fax Number	:	725-205-8594

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2019
Last Update Date	:	09/30/2019

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