| Restoration Healthcare Inc | |
|
18818 Teller Ave Suite 170 Irvine CA 92612-1678 | |
| (949) 535-2322 | |
| Not Available |
| Full Name | Restoration Healthcare Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 18818 Teller Ave, Irvine, California |
| Authorized Official Name and Position | Mary S Raleigh (PRESIDENT) |
| Authorized Official Contact | 9495352322 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restoration Healthcare Inc 18818 Teller Ave Suite 170 Irvine CA 92612-1678 Ph: (949) 535-2322 | Restoration Healthcare Inc 18818 Teller Ave Suite 170 Irvine CA 92612-1678 Ph: (949) 535-2322 |
| NPI Number | 1275931800 |
|---|---|
| Provider Enumeration Date | 12/14/2014 |
| Last Update Date | 02/26/2024 |
| Medicare PECOS PAC ID | 8224358635 |
|---|---|
| Medicare Enrollment ID | O20150527001389 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275931800 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
| Provider Name | Walid A Faraj |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396736245 PECOS PAC ID: 6800865395 Enrollment ID: I20040930001052 |
| Provider Name | Mary S Raleigh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457542094 PECOS PAC ID: 0143397265 Enrollment ID: I20150605000194 |
| Provider Name | Tamara T Kurmanalieva |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720291222 PECOS PAC ID: 6709976343 Enrollment ID: I20170523002078 |
| Provider Name | Eduard Drannikov |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407241524 PECOS PAC ID: 7214295336 Enrollment ID: I20171219002531 |
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