Provider Demographics
NPI:1952047003
Name:RESTORE PRIMARY CARE, WELLNESS AND BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:RESTORE PRIMARY CARE, WELLNESS AND BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FNP
Authorized Official - Prefix:MS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-BC,
Authorized Official - Phone:210-385-8306
Mailing Address - Street 1:24103 RANGE WATER
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2372
Mailing Address - Country:US
Mailing Address - Phone:210-385-8306
Mailing Address - Fax:
Practice Address - Street 1:PARVUS MEDICAL SUITE, LLC
Practice Address - Street 2:WESTOVER HILLS MEDICAL PLAZA II SUITE 240 11212 ST HWY
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251
Practice Address - Country:US
Practice Address - Phone:210-385-8306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty