Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A87656 | CA |
N | 2080P0202X | Pediatric Cardiologist | 39660 | IA |
Y | 2080P0202X | Pediatric Cardiologist | A87656 | CA |
NPI | 1174582845 |
---|---|
Provider Name | Dr. Miguel Santiago Restrepo |
First Address | Madera, CA 93636-8761 |
Second Address | Madera, CA 93636-8761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 16/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1986236 | (05) | CA |
I27752 | (02) | CA |