Provider Demographics
NPI:1225533698
Name:RESTREPO, MONICA C (MCN, RD, LD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:C
Last Name:RESTREPO
Suffix:
Gender:F
Credentials:MCN, RD, LD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:C
Other - Last Name:RESTREPO GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9519 E PEDERNALES RIVER DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6322
Mailing Address - Country:US
Mailing Address - Phone:254-239-9515
Mailing Address - Fax:
Practice Address - Street 1:14511 FALLING CREEK DR STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1279
Practice Address - Country:US
Practice Address - Phone:713-622-6422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84731133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86064536OtherCOMMISSION ON DIETETIC REGISTRATION - ACADEMY OF NUTRITION AND DIETETICS
TXDT84731OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION