Restore Medical Group, a Professional Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

License

A76120 Issued in CA

Legal business name

RESTORE MEDICAL GROUP, A PROFESSIONAL CORPORATION

Practice address

16400 Ventura Blvd
Suite 328
Encino, CA 91436-2137

Phone

(818) 786-9417

Fax

(818) 786-9419

NPI assigned

Oct 3, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Aaaron Coppelson, MD

Title

Owner

Phone

(818) 786-9417

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205798400000",
    "number": "1700970753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 261399",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914261399",
            "telephone_number": "818-786-9417",
            "fax_number": "818-786-9419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16400 VENTURA BLVD",
            "address_2": "SUITE 328",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362137",
            "telephone_number": "818-786-9417",
            "fax_number": "818-786-9419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE MEDICAL GROUP, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2008-03-18",
        "status": "A",
        "authorized_official_last_name": "COPPELSON",
        "authorized_official_first_name": "AAARON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-786-9417",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A76120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1891775235",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "1171563",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Encino, CA
• Providers in Encino, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2008; 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.