Healthcare Provider Details

I. General information

NPI: 1467317172
Provider Name (Legal Business Name): CAROLINE DELAINE LEVANOVIC PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S MAIN ST STE 215
CORONA CA
92882-2533
US

IV. Provider business mailing address

2815 S MAIN ST STE 215
CORONA CA
92882-2533
US

V. Phone/Fax

Practice location:
  • Phone: 951-582-0644
  • Fax:
Mailing address:
  • Phone: 951-582-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPA67406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: