Provider Demographics
NPI:1366113722
Name:RESTORE LABORATORIES INC.
Entity type:Organization
Organization Name:RESTORE LABORATORIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:916-949-6465
Mailing Address - Street 1:5420 ROCKWELL RD # 2
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-4944
Mailing Address - Country:US
Mailing Address - Phone:916-949-6465
Mailing Address - Fax:
Practice Address - Street 1:5420 ROCKWELL RD # 2
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-4944
Practice Address - Country:US
Practice Address - Phone:916-949-6465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory