Individual
THERESA A LONGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
17575 WICKER WAY, RIVERSIDE, CA 92504-9563
(951) 780-9389
(951) 780-9389
Mailing address
17575 WICKER WAY, RIVERSIDE, CA 92504-9563
(951) 961-6529
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
G59848
CA
Other
Enumeration date
10/03/2006
Last updated
12/26/2022
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