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Organization
LONGEVITA CLINIC, A PROFESSIONAL CORPORATION
Active
Organization
LONGEVITA CLINIC, A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD PARK MD (SECRETARY)
(805) 368-1293
Entity
Organization
Contact information
Practice address
21757 DEVONSHIRE ST STE 1, CHATSWORTH, CA 91311-2975
(805) 630-7149
(888) 981-8739
Mailing address
21757 DEVONSHIRE ST STE 1, CHATSWORTH, CA 91311-2975
(818) 678-9875
(747) 200-2589
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
03/09/2021
Last updated
02/24/2023
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