NPI 1023558210

Tustin Longevity Center

Organisation Preferred Provider Organization Tustin, CA

Practice location

Address: 13422 Newport Ave Suite L, Tustin, CA 92780-3746
Phone: (714) 544-1521

Authorised official

Name: Rita R Ellithorpe
Title: Medical Director
Phone: (714) 544-1521

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence G83575 (CA)

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Registry record

NPI: 1023558210
Entity type: Organization
NPI issued: 7 Mar 2017
Record last updated: 7 Mar 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.