Healthcare Provider Details

I. General information

NPI: 1518055011
Provider Name (Legal Business Name): DONALD LEVY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W LA VETA AVE STE 101
ORANGE CA
92868-4447
US

IV. Provider business mailing address

705 W LA VETA AVE STE 101
ORANGE CA
92868-4447
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-7847
  • Fax: 714-639-1978
Mailing address:
  • Phone: 714-639-7847
  • Fax: 714-639-1978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG56847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: