Provider Demographics
NPI:1720685530
Name:RESTREPO, RICARDO JOSE
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:JOSE
Last Name:RESTREPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8351 SANDS POINT BLVD APT A104
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-8541
Mailing Address - Country:US
Mailing Address - Phone:954-203-2664
Mailing Address - Fax:
Practice Address - Street 1:8351 SANDS POINT BLVD APT A104
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-8541
Practice Address - Country:US
Practice Address - Phone:954-203-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)