Healthcare Provider Details

I. General information

NPI: 1124387097
Provider Name (Legal Business Name): MARK DAVID LEVINE, MD FRESNO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 N 6TH ST STE 135
FRESNO CA
93710-7514
US

IV. Provider business mailing address

3841 N FREEWAY BLVD 120
SACRAMENTO CA
95834-1949
US

V. Phone/Fax

Practice location:
  • Phone: 559-490-2067
  • Fax: 559-225-1268
Mailing address:
  • Phone: 916-576-7898
  • Fax: 916-285-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK DAVID LEVINE
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 916-576-7898