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General NPI Number Information
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NPI Number | 1164941092
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Entity Type | Organization
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Legal Business Name | LONGEVITY METRICS MEDICAL GROUP INC
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 34145 PACIFIC COAST HWY # 803
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City | DANA POINT
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State | CA
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Zip | 92629-2808
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Country | US
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Telephone | 949-632-2704
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Fax |
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Provider Business Mailing Address
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Address Line | 34145 PACIFIC COAST HWY # 803
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City | DANA POINT
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State | CA
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Zip | 92629-2808
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Country | US
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Telephone | 949-632-2704
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIC DEC
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Credential | MD
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Telephone | 949-632-2704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number |
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License Number State |
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