Healthcare Provider Details

I. General information

NPI: 1205677002
Provider Name (Legal Business Name): TORI ANN LONG ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76-5914 MAMALAHOA HWY
HOLUALOA HI
96725
US

IV. Provider business mailing address

76-5914 MAMALAHOA HWY
HOLUALOA HI
96725
US

V. Phone/Fax

Practice location:
  • Phone: 702-569-1352
  • Fax: 800-214-6316
Mailing address:
  • Phone: 702-569-1352
  • Fax: 800-214-6316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: