Provider Demographics
NPI:1649811878
Name:RESTREPO, HUMBERTO (OMD)
Entity type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:
Last Name:RESTREPO
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7487 PALERMO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-5156
Mailing Address - Country:US
Mailing Address - Phone:702-682-3767
Mailing Address - Fax:
Practice Address - Street 1:5594 S FORT APACHE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-3610
Practice Address - Country:US
Practice Address - Phone:702-763-1168
Practice Address - Fax:725-205-8594
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-29
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2027171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty