Organization
ARLINGTON LONGEVITY INSTITUTE
Active
Parent organization
ARLINGTON LONGEVITY INSTITUTE
Organization subpart
Yes
Provider details
NPI number
Legal business name
ARLINGTON LONGEVITY INSTITUTE
Authorized official
DR. TERRILL K. HAWS D.O. (MEDICAL DIRECTOR)
(847) 549-1424
Entity
Organization
Contact information
Practice address
655 CAMINO DE LOS MARES STE 117, SAN CLEMENTE, CA 92673-2809
(949) 391-0464
Mailing address
655 CAMINO DE LOS MARES STE 117, SAN CLEMENTE, CA 92673-2809
(949) 391-0464
Taxonomy
Speciality
Code
Description
License number
State
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
036073100
IL
261Q00000X
Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
036073100
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
788850
MEDICARE NON-SPECIFIED NUMBER
IL
Enumeration date
02/14/2010
Last updated
02/03/2021
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