Provider Demographics
NPI:1184944332
Name:RESTORIX MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:RESTORIX MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FALLOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-688-3734
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:#210
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-0190
Mailing Address - Country:US
Mailing Address - Phone:425-688-3730
Mailing Address - Fax:
Practice Address - Street 1:1515 116TH AVE NE
Practice Address - Street 2:SUITE 300
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3811
Practice Address - Country:US
Practice Address - Phone:425-313-4800
Practice Address - Fax:425-391-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60152113174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty