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Organization
RESTORE MEDICAL GROUP, A PROFESSIONAL CORPORATION
Active
Organization
RESTORE MEDICAL GROUP, A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AAARON COPPELSON MD (OWNER)
(818) 786-9417
Entity
Organization
Contact information
Practice address
16400 VENTURA BLVD, SUITE 328, ENCINO, CA 91436-2137
(818) 786-9417
(818) 786-9419
Mailing address
PO BOX 261399, ENCINO, CA 91426-1399
(818) 786-9417
(818) 786-9419
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A76120
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1171563
CAQH
CA
01
—
1891775235
NPI
CA
Enumeration date
10/03/2006
Last updated
03/18/2008
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