MEDICARE: DR. JOSEPH MILTON LONGNECKER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	B58230	CA
2	208000000X	Pediatrics Physician	20A3180	CA
3	207Q00000X	Family Medicine Physician	20A3180	CA

General Provider Information

NPI Number	:	1326049263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH MILTON LONGNECKER D.O.

Provider Business Mailing Address
First Line	:	1041 E. YORBA LINDA BLVD.
Second Line	:	SUITE 306
City	:	PLACENTIA
State	:	CA
Zip	:	92870-0000
Country	:	US
Telephone Number	:	714-577-9500
Fax Number	:	714-577-9504

Provider Business Practice Location Address
First Line	:	1041 E. YORBA LINDA BLVD.
Second Line	:	SUITE 306
City	:	PLACENTIA
State	:	CA
Zip	:	92870-0000
Country	:	US
Telephone Number	:	714-577-9500
Fax Number	:	714-577-9504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	10/29/2015

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