Provider Demographics
NPI:1790041986
Name:RESTREPO, CARLOS ANDRES (LAC)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ANDRES
Last Name:RESTREPO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 GLADES RD STE 430W
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-8533
Mailing Address - Country:US
Mailing Address - Phone:954-825-3670
Mailing Address - Fax:
Practice Address - Street 1:2300 GLADES RD STE 430W
Practice Address - Street 2:SUITE 106
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-8533
Practice Address - Country:US
Practice Address - Phone:954-825-3670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3080171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist