MEDICARE: LEVI MARTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	66820	CA

General Provider Information

NPI Number	:	1255044251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEVI MARTIN

Provider Business Mailing Address
First Line	:	145 PARK LN STE 120
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-2116
Country	:	US
Telephone Number	:	661-302-2284
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 PARK LN STE 120
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-2116
Country	:	US
Telephone Number	:	805-372-2886
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2023
Last Update Date	:	11/05/2025

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Directions to “ LEVI MARTIN ” Practice Location

Language	Start Address	Practice Location

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