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General NPI Number Information
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NPI Number | 1104127703
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Entity Type | Organization
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Legal Business Name | TONI L LONG M D A MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/12/2010
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Last Update Date | 11/12/2010
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Provider Practice Location Address
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Address Line | 2020 SANTA MONICA BLVD STE 570
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City | SANTA MONICA
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State | CA
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Zip | 90404-2131
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Country | US
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Telephone | 310-453-9289
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Fax | 310-453-2161
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Provider Business Mailing Address
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Address Line | 2020 SANTA MONICA BLVD STE 570
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City | SANTA MONICA
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State | CA
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Zip | 90404-2131
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Country | US
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Telephone | 310-453-9289
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Fax | 310-453-2161
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Authorized Official
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Title or Position | BILLER
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Name | MS. MONICA M WENZEL
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Credential |
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Telephone | 310-915-9154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G65155
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License Number State | CA
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