1275838229 NPI number — RESTORIX MEDICAL GROUP OF CALIFORNIA PC

Table of content: (NPI 1275838229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275838229 NPI number — RESTORIX MEDICAL GROUP OF CALIFORNIA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESTORIX MEDICAL GROUP OF CALIFORNIA PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275838229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98009-0190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-688-3730
Provider Business Mailing Address Fax Number:
425-453-6345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28078 BAXTER ROAD
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92563-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-566-9800
Provider Business Practice Location Address Fax Number:
951-566-9801
Provider Enumeration Date:
01/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
FALLOU
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
425-688-3734

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  20A7477 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com