Organization
TIMELESS MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER MIGNOSA D.O. (PRESIDENT)
(714) 323-8261
Entity
Organization
Contact information
Practice address
6751 BRIDGEWATER DR, HUNTINGTON BEACH, CA 92647-4019
(714) 323-8261
Mailing address
6751 BRIDGEWATER DR, HUNTINGTON BEACH, CA 92647-4019
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
20A12464
CA
Other
Enumeration date
10/08/2015
Last updated
10/08/2015
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