Provider Demographics
NPI:1922433267
Name:TESTOSTERONE AND LONGEVITY CENTER
Entity Type:Organization
Organization Name:TESTOSTERONE AND LONGEVITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:FALER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:425-264-5678
Mailing Address - Street 1:5335 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4831
Mailing Address - Country:US
Mailing Address - Phone:425-264-5678
Mailing Address - Fax:425-264-5679
Practice Address - Street 1:5335 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4831
Practice Address - Country:US
Practice Address - Phone:425-264-5678
Practice Address - Fax:425-264-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001500175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty