Individual
MS. AYA RESTREPO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
305 N LEROY ST, FENTON, MI 48430-2729
(810) 629-9200
(810) 629-9653
Mailing address
305 N LEROY ST, FENTON, MI 48430-2729
(810) 629-9200
(810) 629-9653
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005647
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700H231390
BCBSM GROUP NUMBER
MI
Enumeration date
02/04/2010
Last updated
07/21/2022
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