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AGELESS MEN'S HEALTH CA PC
NPI 1245561828
Internal Medicine in Los Angeles, CA

Active since January 21, 2010CLIA 05D2031303 · Waiver
11633 SAN VINCENTE BLVD, SUITE 214, LOS ANGELES, CA 90049(310) 979-8378(310) 979-8379 Get Directions Write a Review

NPPES record last updated: November 11, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 11, 2024, Nov 13, 2023, Mar 20, 2023 (3 updates tracked since 2023).

About Ageless Men's Health Ca Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AGELESS MEN'S HEALTH CA PC (NPI 1245561828) is a healthcare organization registered as an internal medicine in Los Angeles, California and active in the NPI registry since January 2010. The organization holds a CLIA Waiver certificate valid through October 16, 2027 and lists Amanda Wilkinson, Business Operations Director, as its authorized official.

NPPES Registry Identity

NPI1245561828
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameAGELESS MEN'S HEALTH CA PC
Location Address11633 SAN VINCENTE BLVD, SUITE 214Los Angeles, CA 90049
Mailing Address11633 San Vincente Blvd, Suite 214Los Angeles, CA 90049 · (310) 979-8378 · Fax (310) 979-8379
Phone(310) 979-8378
Fax(310) 979-8379
Organization SubpartYesParent: Ageless Men's Health
Authorized OfficialAmanda WilkinsonBusiness Operations Director · (702) 818-0446
Enumeration DateJanuary 21, 2010
Last NPPES UpdateNovember 11, 20243 updates tracked since enumeration
NPPES CertifiedNovember 11, 2024
✔ NPI 1245561828 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in CA · PA13875
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
11633 SAN VINCENTE BLVD, Los Angeles, CA 90049
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2031303

Ageless Men's Health- Santa Monica · Los Angeles, CA
Active · expires Oct 16, 2027
CLIA Number05D2031303
Laboratory TypePhysician Office
Certificate Effective DateOctober 17, 2025
Certificate Expiration DateOctober 16, 2027
Laboratory DirectorJohn D. Dorman, MD
Laboratory Phone(310) 979-8378
Laboratory LocationAgeless Men's Health- Santa Monica11633 San Vicente Blvd Ste 214, Los Angeles, CA 90049
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DIXIE D RICHARDS MD INC
Dermatology
11633 SAN VINCENTE BLVD, SUITE 310
LOS ANGELES, CA 90049
Los Angeles County (310) 826-5949

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ageless Men's Health Ca PC's NPI number?

The NPI number for Ageless Men's Health Ca PC is 1245561828. It was assigned to this organization in the NPPES registry on January 21, 2010.

Where is Ageless Men's Health Ca PC located?

Ageless Men's Health Ca PC is located at 11633 San Vincente Blvd Suite 214, Los Angeles, CA 90049. The listed phone number is (310) 979-8378.

What is Ageless Men's Health Ca PC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Ageless Men's Health Ca PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2031303) is associated with this NPI, valid through October 16, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Ageless Men's Health Ca PC was last updated on November 11, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.