Provider Demographics
NPI:1245214766
Name:RECIO-RESTREPO, MARIA V (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:V
Last Name:RECIO-RESTREPO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12306 WOODLANDS CIR
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-8283
Mailing Address - Country:US
Mailing Address - Phone:775-567-8155
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:12306 WOODLANDS CIR
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-8283
Practice Address - Country:US
Practice Address - Phone:864-735-4757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-014482084N0400X
SC277752084N0400X
NV178212084N0400X, 2084V0102X
TXP02802084N0400X
ARE-120662084N0400X
WI30442084N0400X
FLME1404372084N0400X
TNMD00000519362084N0400X
MS268562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC277756Medicaid
11767959OtherCAQH
TX285755901Medicaid
SCI47750Medicare UPIN
TX285755901Medicaid
SCAA11918408Medicare PIN
P00320237Medicare PIN
TXTXB139152Medicare PIN