Provider Demographics
NPI:1114426285
Name:RIOS RESTREPO, LINA MARCELA (FNP)
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:MARCELA
Last Name:RIOS RESTREPO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LINA
Other - Middle Name:MARCELA
Other - Last Name:RIOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:3280 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3103
Mailing Address - Country:US
Mailing Address - Phone:626-583-3430
Mailing Address - Fax:
Practice Address - Street 1:1365 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5047
Practice Address - Country:US
Practice Address - Phone:626-857-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008488363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner