Individual
DIANNE LONGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1319 EVERGREEN AVE, APT N2, FULLERTON, CA 92835-2063
(714) 697-8359
Mailing address
1319 EVERGREEN AVE, APT N2, FULLERTON, CA 92835-2063
(714) 697-8359
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
2251P0200X
CA
Other
Enumeration date
03/03/2014
Last updated
03/03/2014
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