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General NPI Number Information
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NPI Number | 1174909691
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Entity Type | Organization
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Legal Business Name | RESTORE U, LLC
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Dates
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Enumeration Date | 08/06/2015
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 3015 CALLOWAY DR STE D6D7D8
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City | BAKERSFIELD
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State | CA
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Zip | 93312-2657
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Country | US
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Telephone | 702-415-3716
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Fax |
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Provider Business Mailing Address
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Address Line | 3960 HOWARD HUGHES PKWY STE 500
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City | LAS VEGAS
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State | NV
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Zip | 89169-5988
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Country | US
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Telephone | 702-415-3716
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL FITCH
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Credential |
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Telephone | 702-415-3716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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