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General NPI Number Information
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NPI Number | 1336084540
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Entity Type | Organization
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Legal Business Name | RENEWED GRACE RESTORATION LLC
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Dates
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Enumeration Date | 04/22/2026
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Last Update Date | 04/22/2026
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Provider Practice Location Address
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Address Line | 12785 ELMHURST DR
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City | MORENO VALLEY
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State | CA
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Zip | 92555-2359
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Country | US
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Telephone | 951-268-0825
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 CANYON SPRINGS PKWY STE 1096
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City | RIVERSIDE
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State | CA
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Zip | 92507-0961
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Country | US
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Telephone | 951-268-0825
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WINNIKKIA PERKINS
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Credential |
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Telephone | 951-268-0825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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