| Restivo Plastic Surgery-maui | |
|
100 Wailea Ike Dr Unit 7 Wailea HI 96753-9514 | |
| (808) 868-3888 | |
| (808) 868-3003 |
| Full Name | Restivo Plastic Surgery-maui |
|---|---|
| Speciality | Plastic Surgery |
| Location | 100 Wailea Ike Dr Unit 7, Wailea, Hawaii |
| Authorized Official Name and Position | Terry Restivo (DO) |
| Authorized Official Contact | 8088683888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restivo Plastic Surgery-maui 100 Wailea Ike Dr Unit 7 Wailea HI 96753-9514 Ph: (808) 868-3888 | Restivo Plastic Surgery-maui 100 Wailea Ike Dr Unit 7 Wailea HI 96753-9514 Ph: (808) 868-3888 |
| NPI Number | 1437536836 |
|---|---|
| Provider Enumeration Date | 05/05/2015 |
| Last Update Date | 05/10/2023 |
| Medicare PECOS PAC ID | 0749664191 |
|---|---|
| Medicare Enrollment ID | O20220902000347 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437536836 | NPI | - | NPPES |
| 1609036425 | Other | CA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | P0927 (Texas) | Secondary |
| 208200000X | Plastic Surgery | 20A9243 (California) | Primary |
| Provider Name | Terry Ellen Restivo |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1609036425 PECOS PAC ID: 2961718150 Enrollment ID: I20200303001335 |
Wailea Medical Group Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 161 Wailea Ike Pl, #b102, Wailea, HI 96753 Phone: 808-875-9095 Fax: 808-875-9098 |