TUSTIN LONGEVITY CENTER NPI 1023558210

NPI Information

  • NPI: 1023558210
  • Provider Name: TUSTIN LONGEVITY CENTER
  • Classification: Preferred Provider Organization - 305R00000X
  • Entity Type: Organization
  • Address: 13422 NEWPORT AVE
    SUITE L
    TUSTIN, CA
    ZIP 92780
  • Phone: (714) 544-1521

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NPI Details

TUSTIN LONGEVITY CENTER is a preferred provider organization in Tustin, CA. The provider is a group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. TUSTIN LONGEVITY CENTER NPI is 1023558210. The provider is registered as an organization entity type.

The provider's business location address is:

13422 NEWPORT AVE
SUITE L
TUSTIN, CA
ZIP 92780-746
Phone: (714) 544-1521

The provider's authorized official is Rita R Ellithorpe .
The authorized official title is Medical Director and has the following contact phone number (714) 544-1521.

The enumeration date for this NPI number is 3/7/2017 and was last updated on 3/7/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1305R00000XPreferred Provider OrganizationG83575CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1G83575MEDICARE UPINCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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