Provider Demographics
NPI:1609036425
Name:RESTIVO, TERRY ELLEN (MA DO)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ELLEN
Last Name:RESTIVO
Suffix:
Gender:F
Credentials:MA DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
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:808-868-3888
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
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9243208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery