Healthcare Provider Details

I. General information

NPI: 1265992168
Provider Name (Legal Business Name): JOSHUA LEVY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 09/19/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 H ST APT 3
SACRAMENTO CA
95819-2753
US

IV. Provider business mailing address

5716 FOLSOM BLVD STE 142
SACRAMENTO CA
95819-4608
US

V. Phone/Fax

Practice location:
  • Phone: 707-375-3891
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA180121
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberA180121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: