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General NPI Number Information
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NPI Number | 1790668085
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Entity Type | Organization
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Legal Business Name | LONGEVITY NEUROLOGY CENTER
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Dates
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Enumeration Date | 07/26/2025
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Last Update Date | 07/26/2025
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Provider Practice Location Address
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Address Line | 14362 N FRANK LLOYD WRIGHT BLVD STE 1340
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-8878
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Country | US
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Telephone | 480-770-0427
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Fax | 480-770-0428
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Provider Business Mailing Address
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Address Line | 13238 N 79TH ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-4016
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Country | US
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Telephone | 336-624-3247
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TASHA POWELL
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Credential | MD
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Telephone | 480-770-0427
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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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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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