Provider Demographics
NPI:1437536836
Name:RESTIVO PLASTIC SURGERY-MAUI
Entity Type:Organization
Organization Name:RESTIVO PLASTIC SURGERY-MAUI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RESTIVO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-868-3888
Mailing Address - Street 1:100 WAILEA IKE DR UNIT 7
Mailing Address - Street 2:
Mailing Address - City:WAILEA
Mailing Address - State:HI
Mailing Address - Zip Code:96753-9514
Mailing Address - Country:US
Mailing Address - Phone:808-868-3888
Mailing Address - Fax:808-868-3003
Practice Address - Street 1:100 WAILEA IKE DR UNIT 7
Practice Address - Street 2:
Practice Address - City:WAILEA
Practice Address - State:HI
Practice Address - Zip Code:96753-9514
Practice Address - Country:US
Practice Address - Phone:808-868-3888
Practice Address - Fax:808-868-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9243208200000X
TXP0927261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609036425OtherNPI