Provider Demographics
NPI:1710435144
Name:RESTORING HEALTH MEDICAL INSTITUTE, INC.
Entity Type:Organization
Organization Name:RESTORING HEALTH MEDICAL INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOSSAZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:888-774-3254
Mailing Address - Street 1:11540 SANTA MONICA BLVD SUITE 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:888-774-3254
Mailing Address - Fax:
Practice Address - Street 1:11540 SANTA MONICA BLVD SUITE 204
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:888-774-3254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11456261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center