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General NPI Number Information
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NPI Number | 1437536836
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Entity Type | Organization
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Legal Business Name | RESTIVO PLASTIC SURGERY-MAUI
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 100 WAILEA IKE DR UNIT 7
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City | WAILEA
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State | HI
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Zip | 96753-9514
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Country | US
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Telephone | 808-868-3888
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Fax | 808-868-3003
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Provider Business Mailing Address
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Address Line | 100 WAILEA IKE DR UNIT 7
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City | WAILEA
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State | HI
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Zip | 96753-9514
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Country | US
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Telephone | 808-868-3888
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Fax | 808-868-3003
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Authorized Official
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Title or Position | DO
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Name | TERRY RESTIVO
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Credential | DO
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Telephone | 808-868-3888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | P0927
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 20A9243
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License Number State | CA
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