Healthy Longevity Medical Center

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

HEALTHY LONGEVITY MEDICAL CENTER

Practice address

441 E Carson St Ste K
Carson, CA 90745-7713

Phone

(949) 413-1955

NPI assigned

Jun 1, 2023

Organization subpart

No

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

Authorized official

Name

Miss Aida Souleiman, NP

Title

Owner

Phone

(949) 413-1955

Specialties & licenses 2

Addresses

Other names 2

• Healthy longevity Medical Center Doing business as
• infinity Summer Services Doing business as

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

{
    "created_epoch": "1685577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1912690132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "552 E CARSON ST APT 409",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907452890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "441 E CARSON ST STE K",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907457713",
            "telephone_number": "949-413-1955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY LONGEVITY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-01",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A",
        "authorized_official_last_name": "SOULEIMAN",
        "authorized_official_first_name": "AIDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-413-1955",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthy longevity Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "infinity Summer Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dionne Lashon Henderson, PA-C

• Clinic/Center in Carson, CA
• Providers in Carson, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; 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.