Provider Demographics
NPI:1275838229
Name:RESTORIX MEDICAL GROUP OF CALIFORNIA PC
Entity Type:Organization
Organization Name:RESTORIX MEDICAL GROUP OF CALIFORNIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FALLOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-688-3734
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-0190
Mailing Address - Country:US
Mailing Address - Phone:425-688-3730
Mailing Address - Fax:425-453-6345
Practice Address - Street 1:28078 BAXTER ROAD
Practice Address - Street 2:SUITE 410
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-1400
Practice Address - Country:US
Practice Address - Phone:951-566-9800
Practice Address - Fax:951-566-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7477174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty