Provider Demographics
NPI:1124451299
Name:AGELESS MEN'S HEALTH PC
Entity type:Organization
Organization Name:AGELESS MEN'S HEALTH PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-818-0446
Mailing Address - Street 1:100 MONTGOMERY ST
Mailing Address - Street 2:SUITE 2290
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4331
Mailing Address - Country:US
Mailing Address - Phone:949-854-8378
Mailing Address - Fax:949-854-8379
Practice Address - Street 1:100 MONTGOMERY ST
Practice Address - Street 2:SUITE 2290
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-4331
Practice Address - Country:US
Practice Address - Phone:949-854-8378
Practice Address - Fax:949-854-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty