Healthcare Provider Details

I. General information

NPI: 1558565416
Provider Name (Legal Business Name): THOMAS M LEVERONE M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 GREEN VALLEY RD
FREEDOM CA
95019-3160
US

IV. Provider business mailing address

PO BOX 3999
TORRANCE CA
90510-3999
US

V. Phone/Fax

Practice location:
  • Phone: 831-763-9700
  • Fax:
Mailing address:
  • Phone: 310-792-3914
  • Fax: 310-792-3621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG55783
License Number StateCA

VIII. Authorized Official

Name: DR. THOMAS M LEVERONE
Title or Position: INCORPORATOR
Credential: M.D.
Phone: 310-792-3914