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General NPI Number Information
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NPI Number | 1427400167
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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 | 07/06/2016
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 4727 SAN PABLO AVE ROOM B214
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City | EMERYVILLE
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State | CA
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Zip | 94608-3035
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Country | US
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Telephone | 510-981-4100
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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 |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. MARTIN LYNCH
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Credential | PHD
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Telephone | 510-981-4123
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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 |
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License Number State |
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