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General NPI Number Information
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NPI Number | 1225513385
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Entity Type | Organization
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Legal Business Name | RESTAURA HEALTH LLC
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 924 W SPRING ST
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City | MONROE
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State | GA
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Zip | 30655-1751
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Country | US
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Telephone | 770-266-0933
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Fax |
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Provider Business Mailing Address
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Address Line | 924 W SPRING ST
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City | MONROE
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State | GA
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Zip | 30655-1751
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARIBELLE VERDIALES
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Credential | MD
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Telephone | 706-248-6472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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