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General NPI Number Information
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NPI Number | 1700970753
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Entity Type | Organization
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Legal Business Name | RESTORE MEDICAL GROUP, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 16400 VENTURA BLVD SUITE 328
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City | ENCINO
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State | CA
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Zip | 91436-2137
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Country | US
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Telephone | 818-786-9417
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Fax | 818-786-9419
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Provider Business Mailing Address
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Address Line | PO BOX 261399
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City | ENCINO
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State | CA
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Zip | 91426-1399
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Country | US
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Telephone | 818-786-9417
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Fax | 818-786-9419
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Authorized Official
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Title or Position | OWNER
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Name | DR. AAARON COPPELSON
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Credential | MD
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Telephone | 818-786-9417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A76120
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License Number State | CA
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