Provider Demographics
NPI:1275931800
Name:RESTORATION HEALTHCARE INC
Entity Type:Organization
Organization Name:RESTORATION HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:RALEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-535-2322
Mailing Address - Street 1:18818 TELLER AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1678
Mailing Address - Country:US
Mailing Address - Phone:949-535-2322
Mailing Address - Fax:
Practice Address - Street 1:18818 TELLER AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1678
Practice Address - Country:US
Practice Address - Phone:949-535-2322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-14
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB232829Medicare PIN