Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 230970 | MA |
NPI | 1093876906 |
---|---|
Provider Name | Dr. Irving Raul Restituyo |
First Address | Acushnet, MA 02743-2743 |
Second Address | New Bedford, MA 02740-5405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |