Provider Demographics
NPI:1245439686
Name:RESTAINO, NIVEDITA GHOSH (MD)
Entity type:Individual
Prefix:
First Name:NIVEDITA
Middle Name:GHOSH
Last Name:RESTAINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIVEDITA
Other - Middle Name:
Other - Last Name:GHOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4855 ARIVA WAY
Mailing Address - Street 2:APT 312
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8810 RIO SAN DIEGO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1698
Practice Address - Country:US
Practice Address - Phone:619-400-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233366207R00000X
CAC140222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine