Provider Demographics
NPI:1316900814
Name:RESTORATIVE SOLUTIONS
Entity type:Organization
Organization Name:RESTORATIVE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONDY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SCIPPIO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:209-477-8327
Mailing Address - Street 1:2027 GRAND CANAL BLVD
Mailing Address - Street 2:SUITE 31
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6650
Mailing Address - Country:US
Mailing Address - Phone:209-477-8327
Mailing Address - Fax:209-477-9470
Practice Address - Street 1:2027 GRAND CANAL BLVD
Practice Address - Street 2:SUITE 31
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6650
Practice Address - Country:US
Practice Address - Phone:209-477-8327
Practice Address - Fax:209-477-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4939140002Medicare NSC