MEDICARE: ALYSE LEVINE RD, MS

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	133V00000X	Registered Dietitian	926480	NY

General Provider Information

NPI Number	:	1467505115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSE LEVINE RD, MS

Provider Business Mailing Address
First Line	:	1901 AVENUE OF THE STARS
Second Line	:	SUITE 200
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-6001
Country	:	US
Telephone Number	:	310-526-7872
Fax Number	:	310-564-0399

Provider Business Practice Location Address
First Line	:	1901 AVENUE OF THE STARS
Second Line	:	SUITE 200
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-6001
Country	:	US
Telephone Number	:	310-526-7872
Fax Number	:	310-564-0399

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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