Healthcare Provider Details

I. General information

NPI: 1437706124
Provider Name (Legal Business Name): RONALD M LEVIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 FLETCHER PKWY STE 100
LA MESA CA
91942-3128
US

IV. Provider business mailing address

8158 SANTALUZ VILLAGE GRN N
SAN DIEGO CA
92127-2520
US

V. Phone/Fax

Practice location:
  • Phone: 619-698-0930
  • Fax: 619-698-3093
Mailing address:
  • Phone: 858-382-5689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD MALCOLM LEVIN
Title or Position: PRESIDENT
Credential: MD
Phone: 858-382-5689