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NPI Code Detail

MEDICARE: LIFELONG MEDICAL CARE

MEDICARE: LIFELONG MEDICAL CARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QA0505XAdult Medicine Physician140000191CA
2207QG0300XGeriatric Medicine (Family Medicine) Physician140000191CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689670002
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFELONG MEDICAL CARE
Provider Business Mailing Address
First Line : PO BOX 11247
Second Line :
City : BERKELEY
State : CA
Zip : 94712-2247
Country : US
Telephone Number : 510-981-4100
Fax Number :
Provider Business Practice Location Address
First Line : 3260 SACRAMENTO ST
Second Line :
City : BERKELEY
State : CA
Zip : 94702-2739
Country : US
Telephone Number : 510-428-4500
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. MARTY LYNCH
Credential : N/A
Telephone Number : 510-981-4100
Provider Enumeration Date : 06/21/2005
Last Update Date : 10/23/2009

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Directions to “LIFELONG MEDICAL CARE ” Practice Location

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