Healthcare Provider Details

I. General information

NPI: 1417478702
Provider Name (Legal Business Name): MICHELLE A LEVIN M D INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 W 5TH ST
OXNARD CA
93030-6424
US

IV. Provider business mailing address

5855 OLIVAS PARK DR
VENTURA CA
93003-7672
US

V. Phone/Fax

Practice location:
  • Phone: 805-667-3909
  • Fax: 805-667-3910
Mailing address:
  • Phone: 805-667-2801
  • Fax: 805-667-2865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA130179
License Number StateCA

VIII. Authorized Official

Name: SONIA CHAVEZ
Title or Position: INSURANCE CONTRACTOR
Credential:
Phone: 805-652-5469