Healthcare Provider Details

I. General information

NPI: 1942687421
Provider Name (Legal Business Name): RACHEL LEVEY CARUSO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL LEVEY DO

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13471 W CORNERSTONE BLVD
GOODYEAR AZ
85395-2713
US

IV. Provider business mailing address

13471 W CORNERSTONE BLVD
GOODYEAR AZ
85395-2713
US

V. Phone/Fax

Practice location:
  • Phone: 877-809-5092
  • Fax: 623-213-8536
Mailing address:
  • Phone: 877-809-5092
  • Fax: 623-213-8536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number007581
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: