Tustin Longevity Center

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

G83575 Issued in CA

Legal business name

TUSTIN LONGEVITY CENTER

Practice address

13422 Newport Ave
Suite L
Tustin, CA 92780-3746

Phone

(714) 544-1521

NPI assigned

Mar 7, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rita R Ellithorpe, MDNPI 1306848809

Title

Medical Director

Phone

(714) 544-1521

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rita Renee Ellithorpe, M.D.

  • General Practice Physician
  • Tustin, CA
  • NPI 1306848809
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488844800000",
    "number": "1023558210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13422 NEWPORT AVE",
            "address_2": "SUITE L",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803746",
            "telephone_number": "714-544-1521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13422 NEWPORT AVE",
            "address_2": "SUITE L",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803746",
            "telephone_number": "714-544-1521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUSTIN LONGEVITY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-07",
        "last_updated": "2017-03-07",
        "status": "A",
        "authorized_official_last_name": "ELLITHORPE",
        "authorized_official_first_name": "RITA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "714-544-1521",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "G83575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tustin Hospital and Medical Center
• Tustin Hospital and Medical Center
• Tustin Hospital and Medical Center (Newport Specialty Hospital)
• Tustin Hospital and Medical Center
• Tustin Irvine Internal Medicine Group Inc.
• Tustin Longevity Center
• Tustin Pharmacy, Inc. (Tustin Pharmacy)
• Tustin Physical Therapy Specialists, Inc.
• Tustin Place Medical Group
• Tustin Podiatry Clinic Inc

• Preferred Provider Organization in Tustin, CA
• Providers in Tustin, CA by specialty
• Preferred Provider Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.