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1083111371
O LONGEVITY & WELLNESS, PLLC
SCOTTSDALE, AZ
NPI
1083111371
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Entity Type
Organization
Authorized Contact
KEN SHADMAN OTA
Physician
480-365-8035
Organization Subpart ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: AZ 5305)
Enumeration Date
2018-04-12
Last Update Date
2019-08-30
Business Address
O LONGEVITY & WELLNESS, PLLC
9821 N 95TH ST STE 101
SCOTTSDALE, AZ 85258-4589
Phone number: 480-416-0403
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Mailing Address
O LONGEVITY & WELLNESS, PLLC
9821 N 95TH ST STE 101
SCOTTSDALE, AZ 85258-4589
Phone number: 480-365-8035
Copy
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