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General NPI Number Information
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NPI Number | 1194644310
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Entity Type | Organization
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Legal Business Name | HAWAII LONGEVITY AND REGENERATIVE MEDICINE LLC
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Dates
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Enumeration Date | 07/13/2026
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 76-5914 MAMALAHOA HIGHWAY
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City | HOLUALOA
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State | HI
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Zip | 96725
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Country | US
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Telephone | 702-569-1352
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1433
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City | KEALAKEKUA
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State | HI
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Zip | 96750-1433
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Country | US
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Telephone | 702-569-1352
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TORI ANN LONG
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Credential | ND
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Telephone | 702-569-1352
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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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