Provider Demographics
NPI:1124717798
Name:RESTORATIVE HEALTH & WELLNESS INC
Entity type:Organization
Organization Name:RESTORATIVE HEALTH & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:CASIDA
Authorized Official - Suffix:
Authorized Official - Credentials:RNP
Authorized Official - Phone:559-294-4794
Mailing Address - Street 1:PO BOX 25042
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5042
Mailing Address - Country:US
Mailing Address - Phone:559-892-4500
Mailing Address - Fax:559-892-4550
Practice Address - Street 1:1233 W SHAW AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3718
Practice Address - Country:US
Practice Address - Phone:559-206-7680
Practice Address - Fax:559-892-4550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty