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Organization
RESTORE VITALITY CENTER
Active
Organization
RESTORE VITALITY CENTER
Active
Other names
Restore Vitality Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL NELSON (OWNER/MEMBER)
(602) 814-2559
Entity
Organization
Contact information
Practice address
8133 W HEATHERBRAE DR, PHOENIX, AZ 85033-2336
(602) 814-2559
Mailing address
8133 W HEATHERBRAE DR, PHOENIX, AZ 85033-2336
(602) 814-2559
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
AZ
204R00000X
Electrodiagnostic Medicine Physician
—
AZ
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
AZ
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
AZ
207RG0100X
Gastroenterology Physician
—
AZ
2081N0008X
Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
—
AZ
Other
Enumeration date
01/03/2018
Last updated
01/03/2018
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