Healthcare Provider Details

I. General information

NPI: 1619188760
Provider Name (Legal Business Name): NADINE ANNE LEVINSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30011 IVY GLENN DR STE 105
LAGUNA NIGUEL CA
92677-5015
US

IV. Provider business mailing address

30011 IVY GLENN DR STE 105
LAGUNA NIGUEL CA
92677-5015
US

V. Phone/Fax

Practice location:
  • Phone: 949-495-3332
  • Fax: 949-496-0723
Mailing address:
  • Phone: 949-495-3332
  • Fax: 949-496-0723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberRP033
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD21031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: