Healthcare Provider Details

I. General information

NPI: 1003736877
Provider Name (Legal Business Name): LONGEV
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 PROSPECT ST STE 130
LA JOLLA CA
92037-4260
US

IV. Provider business mailing address

888 PROSPECT ST STE 130
LA JOLLA CA
92037-4260
US

V. Phone/Fax

Practice location:
  • Phone: 619-363-5132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON KALASHO
Title or Position: PRESIDENT
Credential: DO
Phone: 619-363-5132