MEDICARE: RESTORATIVE HEALTH & WELLNESS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1124717798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATIVE HEALTH & WELLNESS INC

Provider Business Mailing Address
First Line	:	PO BOX 25042
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93729-5042
Country	:	US
Telephone Number	:	559-892-4500
Fax Number	:	559-892-4550

Provider Business Practice Location Address
First Line	:	1233 W SHAW AVE STE 103
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3718
Country	:	US
Telephone Number	:	559-206-7680
Fax Number	:	559-892-4550

Authorized Official
Title or Position	:	RNP/OWNER
Name	:	DEVON CASIDA
Credential	:	RNP
Telephone Number	:	559-294-4794

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/01/2023

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