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Organization

TUSTIN LONGEVITY CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RITA R ELLITHORPE MD (MEDICAL DIRECTOR)
(714) 544-1521
Entity
Organization

Contact information

Practice address
13422 NEWPORT AVE, SUITE L, TUSTIN, CA 92780-3746
(714) 544-1521
Mailing address
13422 NEWPORT AVE, SUITE L, TUSTIN, CA 92780-3746
(714) 544-1521

Taxonomy

Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
G83575
CA

Other

Enumeration date
03/07/2017
Last updated
03/07/2017
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