Healthcare Provider Details

I. General information

NPI: 1003890971
Provider Name (Legal Business Name): HENRY LEVENSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

PO BOX 1180
CLAREMONT CA
91711-1180
US

V. Phone/Fax

Practice location:
  • Phone: 626-256-6010
  • Fax: 855-266-6110
Mailing address:
  • Phone: 626-256-6010
  • Fax: 855-266-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberG34680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: