Provider Demographics
NPI:1932919180
Name:LONGEVITY FAMILY WELLNESS CLINIC PLLC
Entity type:Organization
Organization Name:LONGEVITY FAMILY WELLNESS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-BC APRN
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN FNP BP
Authorized Official - Phone:956-272-8051
Mailing Address - Street 1:3028 BOYCE CIR N
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-4731
Mailing Address - Country:US
Mailing Address - Phone:956-272-8051
Mailing Address - Fax:
Practice Address - Street 1:3028 BOYCE CIR N
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-4731
Practice Address - Country:US
Practice Address - Phone:956-272-8051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-09
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty