Provider Demographics
NPI:1750104626
Name:RESTORE LIFE LLC
Entity type:Organization
Organization Name:RESTORE LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-392-5200
Mailing Address - Street 1:692 CALLE MEDITERRANEO
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-3632
Mailing Address - Country:US
Mailing Address - Phone:787-936-2600
Mailing Address - Fax:
Practice Address - Street 1:AVE EL COMANDANTE
Practice Address - Street 2:CALLE 266,, 30 COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-392-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty