Healthcare Provider Details

I. General information

NPI: 1417990557
Provider Name (Legal Business Name): PAUL ANDREW LEVITAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S SUNRISE WAY SUITE 300
PALM SPRINGS CA
92262-0118
US

IV. Provider business mailing address

72780 COUNTRY CLUB DR BLDG B 203
RANCHO MIRAGE CA
92270-4126
US

V. Phone/Fax

Practice location:
  • Phone: 760-969-7780
  • Fax: 760-969-7781
Mailing address:
  • Phone: 760-674-3647
  • Fax: 760-674-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG80263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: