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General NPI Number Information
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NPI Number | 1073405429
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Entity Type | Organization
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Legal Business Name | LIFELONG MEDICAL CARE
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 830 UNIVERSITY AVE
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City | BERKELEY
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State | CA
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Zip | 94710-2044
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Country | US
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Telephone | 916-749-6192
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Fax |
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Provider Business Mailing Address
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Address Line | 2344 6TH ST
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City | BERKELEY
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State | CA
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Zip | 94710-2412
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Country | US
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Telephone | 916-749-6192
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | BRENT COPEN
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Credential |
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Telephone | 610-918-4122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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