NPIMap

Organization Active NPI

Restore Health Corp

Doing business as MTM Pharmacy I

  • Long Term Care Pharmacy
  • Garden Grove, CA
National Provider Identifier
1215672613
Registry record updated May 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
RESTORE HEALTH CORP
Doing business as
MTM Pharmacy I
Practice address
12666 Brookhurst St Ste 110
Garden Grove, CA 92840-4866
Phone
(714) 705-6992
NPI assigned
Apr 29, 2022
Last updated
May 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tina Tuyet Quach-TranNPI 1124658471
Title
Owner/President/Ceo
Phone
(714) 705-6992

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU
Long Term Care Pharmacy 3336L0003X NU Primary

Addresses

Primary practice location

12666 Brookhurst St Ste 110
Garden Grove, CA 92840-4866

Mailing address

12666 Brookhurst St Ste 110
Garden Grove, CA 92840-4866
Phone (714) 705-6992

Other identifiers 2

IdentifierTypeStateIssuer
7217942MedicaidCA
PHY57946OtherCAPHARMACY LICENSE

Other names 1

  • MTM Pharmacy I Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Restore Health Corp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651449600000",
    "number": "1215672613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12666 BROOKHURST ST STE 110",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928404866",
            "telephone_number": "714-705-6992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12666 BROOKHURST ST STE 110",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928404866",
            "telephone_number": "714-705-6992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE HEALTH CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-29",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A",
        "authorized_official_last_name": "QUACH-TRAN",
        "authorized_official_first_name": "TINA TUYET",
        "authorized_official_title_or_position": "OWNER/PRESIDENT/CEO",
        "authorized_official_telephone_number": "714-705-6992"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7217942",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "PHY57946",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MTM Pharmacy I",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.