Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | A35521 | CA |
NPI | 1073738365 |
---|---|
Provider Name | Dr. Charles Thoms Longo |
First Address | Sacramento, CA 95819-3441 |
Second Address | Sacramento, CA 95819-3441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |