Rejuvenation & Longevity MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

C39588 Issued in CA

Legal business name

REJUVENATION & LONGEVITY MD

Practice address

4201 Torrance Blvd
Suite 590
Torrance, CA 90503-4504

Phone

(310) 540-0300

Fax

(310) 540-0800

NPI assigned

Jul 13, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Fouad Ghaly, MD

Title

President

Phone

(310) 540-0300

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1278979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278979200000",
    "number": "1770895211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 TORRANCE BLVD",
            "address_2": "SUITE 590",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905034504",
            "telephone_number": "310-540-0300",
            "fax_number": "310-540-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 TORRANCE BLVD",
            "address_2": "SUITE 590",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905034504",
            "telephone_number": "310-540-0300",
            "fax_number": "310-540-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REJUVENATION & LONGEVITY MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-13",
        "last_updated": "2010-07-13",
        "status": "A",
        "authorized_official_last_name": "GHALY",
        "authorized_official_first_name": "FOUAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-540-0300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C39588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Torrance, CA
• Providers in Torrance, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; 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.