Organization
JAMES T. LONG, M.D., PH.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES T. LONG M.D., PH.D. (OWNER)
(310) 395-7392
Entity
Organization
Contact information
Practice address
650 MORENO AVE, LOS ANGELES, CA 90049-4831
(310) 395-7392
(310) 394-7902
Mailing address
650 MORENO AVE, LOS ANGELES, CA 90049-4831
(310) 395-7392
(310) 394-7902
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
G19016
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G19016
MEDICARE PTAN
CA
Enumeration date
02/26/2013
Last updated
02/26/2013
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