Provider Demographics
NPI:1225019003
Name:RESTREPO, SANTIAGO
Entity Type:Individual
Prefix:DR
First Name:SANTIAGO
Middle Name:
Last Name:RESTREPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 E SONTERRA BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4076
Mailing Address - Country:US
Mailing Address - Phone:210-656-2333
Mailing Address - Fax:210-656-1333
Practice Address - Street 1:255 E SONTERRA BLVD STE 211
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4076
Practice Address - Country:US
Practice Address - Phone:210-656-2333
Practice Address - Fax:210-656-1333
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM08822084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM0882OtherTEXAS LICENSE NUMBER