Provider Demographics
NPI:1922621010
Name:RESTO, XIOMARA (MD)
Entity Type:Individual
Prefix:DR
First Name:XIOMARA
Middle Name:
Last Name:RESTO
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:HC 9 BOX 58423
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-9240
Mailing Address - Country:US
Mailing Address - Phone:787-628-8905
Mailing Address - Fax:
Practice Address - Street 1:151 AVE OSVALDO MOLINA
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4013
Practice Address - Country:US
Practice Address - Phone:787-801-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR22390208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program