Healthcare Provider Details

I. General information

NPI: 1356797724
Provider Name (Legal Business Name): ERICA RACHEL LEAVITT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9535 RESEDA BLVD STE 304
NORTHRIDGE CA
91324-6029
US

IV. Provider business mailing address

9535 RESEDA BLVD STE 104
NORTHRIDGE CA
91324-6023
US

V. Phone/Fax

Practice location:
  • Phone: 818-886-3884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA153004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: