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General NPI Number Information
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NPI Number | 1578218251
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Entity Type | Organization
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Legal Business Name | RESTORE PRIMARY CARE, WELLNESS AND BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 02/21/2022
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 24103 RANGE WATER
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City | SAN ANTONIO
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State | TX
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Zip | 78261-2372
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Country | US
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Telephone | 219-385-8306
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Fax |
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Provider Business Mailing Address
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Address Line | 8407 DUDLEY DR
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City | SAN ANTONIO
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State | TX
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Zip | 78230-4520
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Country | US
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Telephone | 210-383-1144
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MS. DENISE HUGHES
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Credential |
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Telephone | 210-383-1144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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