Healthcare Provider Details

I. General information

NPI: 1053054874
Provider Name (Legal Business Name): CAROLINE M LEVAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14550 SOLEDAD CANYON RD
CANYON COUNTRY CA
91387-2200
US

IV. Provider business mailing address

PO BOX 9606
MISSION HILLS CA
91346-9602
US

V. Phone/Fax

Practice location:
  • Phone: 661-250-5200
  • Fax: 661-250-5210
Mailing address:
  • Phone: 213-394-7921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A22315
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: