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General NPI Number Information
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NPI Number | 1275341422
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Entity Type | Organization
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Legal Business Name | RESTORE MEDICAL & WOUND EXPERTS
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 12725 W INDIAN SCHOOL RD STE E101
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City | AVONDALE
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State | AZ
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Zip | 85392-9525
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Country | US
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Telephone | 623-265-3786
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Fax |
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Provider Business Mailing Address
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Address Line | 12725 W INDIAN SCHOOL RD STE E101
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City | AVONDALE
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State | AZ
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Zip | 85392-9525
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Country | US
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Telephone | 623-265-3786
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. MICHAEL BRIONES
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Credential | OTR/L
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Telephone | 623-265-3786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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