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Organization
TUSTIN LONGEVITY CENTER
Active
Organization
TUSTIN LONGEVITY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELAINE DALY (OFFICE MANAGER)
(714) 544-1521
Entity
Organization
Contact information
Practice address
13422 NEWPORT AVE, SUITE L, TUSTIN, CA 92780-3746
(714) 544-1521
(714) 544-1904
Mailing address
13422 NEWPORT AVE, SUITE L, TUSTIN, CA 92780-3746
(714) 544-1521
(714) 544-1904
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/05/2008
Last updated
11/05/2008
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