Organization
RESTORATIVE SPINE AND PAIN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW HADILAKSONO DO (PHYSICIAN)
(310) 500-7966
Entity
Organization
Contact information
Practice address
1050 LAS TABLAS RD STE 12, TEMPLETON, CA 93465-9480
(805) 242-1156
Mailing address
1375 E GRAND AVE STE 103, ARROYO GRANDE, CA 93420-2421
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
07/01/2021
Last updated
07/28/2021
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