Healthcare Provider Details

I. General information

NPI: 1124322656
Provider Name (Legal Business Name): DR. JOSEPH M. LONGNECKER, D.O., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2010
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 E. YORBA LINDA BLVD. SUITE 306
PLACENTIA CA
92870-0000
US

IV. Provider business mailing address

1041 E. YORBA LINDA BLVD. SUITE 306
PLACENTIA CA
92870-0000
US

V. Phone/Fax

Practice location:
  • Phone: 714-577-9500
  • Fax: 714-577-9504
Mailing address:
  • Phone: 714-577-9500
  • Fax: 714-577-9504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number20A3180
License Number StateCA

VIII. Authorized Official

Name: DR. JOSEPH MILTON LONGNECKER
Title or Position: OWNER/PHYSICIAN
Credential: D.O.
Phone: 714-577-9500