Provider Demographics
NPI:1316357122
Name:RESTREPO, ANJELIQUE MARIA (RPA-C)
Entity Type:Individual
Prefix:MISS
First Name:ANJELIQUE
Middle Name:MARIA
Last Name:RESTREPO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3516
Mailing Address - Country:US
Mailing Address - Phone:646-220-1456
Mailing Address - Fax:
Practice Address - Street 1:32 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3516
Practice Address - Country:US
Practice Address - Phone:646-220-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017486363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant