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General NPI Number Information
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NPI Number | 1003032525
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Entity Type | Organization
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Legal Business Name | VITALITY&LONGEVITY MEDICAL CENTER A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 2221 LINCOLN BLVD SUITE 200
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City | SANTA MONICA
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State | CA
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Zip | 90405-1320
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Country | US
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Telephone | 310-581-8585
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Fax | 320-215-4650
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Provider Business Mailing Address
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Address Line | 2221 LINCOLN BLVD SUITE 200
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City | SANTA MONICA
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State | CA
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Zip | 90405-1320
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Country | US
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Telephone | 310-581-8585
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Fax | 320-215-4650
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS J HOPPER
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Credential | M.D.
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Telephone | 310-581-8585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A21560
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License Number State | CA
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