Healthcare Provider Details

I. General information

NPI: 1245441302
Provider Name (Legal Business Name): KRISTIN MAURA LEVITAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N SAN ANTONIO RD #216
LOS ALTOS CA
94022-1373
US

IV. Provider business mailing address

900 N SAN ANTONIO RD #216
LOS ALTOS CA
94022-1373
US

V. Phone/Fax

Practice location:
  • Phone: 650-917-1900
  • Fax: 650-917-1049
Mailing address:
  • Phone: 650-917-1900
  • Fax: 650-917-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberG061477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: