Healthcare Provider Details

I. General information

NPI: 1669437349
Provider Name (Legal Business Name): INNOVATIVE PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 E BASELINE RD #101
GILBERT AZ
85234-2425
US

IV. Provider business mailing address

2915 E BASELINE RD #101
GILBERT AZ
85234-2425
US

V. Phone/Fax

Practice location:
  • Phone: 480-776-0626
  • Fax: 480-776-0627
Mailing address:
  • Phone: 480-776-0626
  • Fax: 480-776-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number23910
License Number StateAZ

VIII. Authorized Official

Name: DR. SANDRA LYNN LEVITT
Title or Position: OWNER
Credential: M.D.
Phone: 480-776-0626