Provider Demographics
NPI:1699363929
Name:RESTORATIVE BREAST CENTER LLC
Entity Type:Organization
Organization Name:RESTORATIVE BREAST CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMAN
Authorized Official - Middle Name:CHAOS
Authorized Official - Last Name:MAHABIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-499-4599
Mailing Address - Street 1:5780 N SWAN RD STE 180
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4527
Mailing Address - Country:US
Mailing Address - Phone:520-448-9490
Mailing Address - Fax:520-448-9492
Practice Address - Street 1:5780 N SWAN RD STE 180
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-4527
Practice Address - Country:US
Practice Address - Phone:520-448-9490
Practice Address - Fax:520-448-9490
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHAOTIQ LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-03
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Single Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty