| Healthy Longevity Medical Center | |
|
441 E Carson St Ste K Carson CA 90745-7713 | |
| (949) 413-1955 | |
| Not Available |
| Full Name | Healthy Longevity Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 441 E Carson St Ste K, Carson, California |
| Authorized Official Name and Position | Aida Souleiman (OWNER) |
| Authorized Official Contact | 9494131955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthy Longevity Medical Center 552 E Carson St Apt 409 Carson CA 90745-2890 Ph: () - | Healthy Longevity Medical Center 441 E Carson St Ste K Carson CA 90745-7713 Ph: (949) 413-1955 |
| NPI Number | 1912690132 |
|---|---|
| Provider Enumeration Date | 06/01/2023 |
| Last Update Date | 06/08/2023 |
| Medicare PECOS PAC ID | 1850750613 |
|---|---|
| Medicare Enrollment ID | O20230711003379 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912690132 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Aida Marie Souleiman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205427150 PECOS PAC ID: 6507245263 Enrollment ID: I20220627001780 |
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