Healthcare Provider Details

I. General information

NPI: 1790390912
Provider Name (Legal Business Name): LEVON J HOWARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 11/27/2023
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 N 61ST AVE
GLENDALE AZ
85301-6613
US

IV. Provider business mailing address

3170 STILLWATER DR
PRESCOTT AZ
86305-7151
US

V. Phone/Fax

Practice location:
  • Phone: 602-386-7364
  • Fax:
Mailing address:
  • Phone: 928-777-3280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number10374473
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: