Healthcare Provider Details

I. General information

NPI: 1205829652
Provider Name (Legal Business Name): NATALIE LYNN RESTIVO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 01/14/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 FT RICHARDSON AVE
GOODFELLOW AFB TX
76908
US

IV. Provider business mailing address

271 FT RICHARDSON AVE
GOODFELLOW AFB TX
76908
US

V. Phone/Fax

Practice location:
  • Phone: 325-654-3634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-07-9742-R
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number35.079742
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number35.079742
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: