Healthcare Provider Details

I. General information

NPI: 1578136511
Provider Name (Legal Business Name): VINCENT JAMES LONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 FRESNO ST
FRESNO CA
93721-1324
US

IV. Provider business mailing address

PO BOX 889442
LOS ANGELES CA
90088-9442
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-6000
  • Fax: 559-451-3661
Mailing address:
  • Phone: 559-603-7372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA193693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: