| Longevite Health And Wellness | |
|
14024 Wiley Cir Midlothian VA 23114-5578 | |
| (804) 639-8145 | |
| (804) 818-2637 |
| Full Name | Longevite Health And Wellness |
|---|---|
| Speciality | Family Medicine |
| Location | 14024 Wiley Cir, Midlothian, Virginia |
| Authorized Official Name and Position | Bernice Natalie Mucius-penha (PHYSICIAN) |
| Authorized Official Contact | 5166738554 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Longevite Health And Wellness 14024 Wiley Cir Midlothian VA 23114-5578 Ph: (804) 639-8145 | Longevite Health And Wellness 14024 Wiley Cir Midlothian VA 23114-5578 Ph: (804) 639-8145 |
| NPI Number | 1730651589 |
|---|---|
| Provider Enumeration Date | 12/18/2018 |
| Last Update Date | 11/13/2022 |
| Medicare PECOS PAC ID | 9234541012 |
|---|---|
| Medicare Enrollment ID | O20201221000522 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730651589 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Bernice N Mucius Penha |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568628527 PECOS PAC ID: 5193994549 Enrollment ID: I20110802000042 |
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