Healthcare Provider Details

I. General information

NPI: 1063701209
Provider Name (Legal Business Name): ROBERT E LEVY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST #1110
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

5820 OWENS DR BLDG E2ND
PLEASANTON CA
94588-3900
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7087
  • Fax:
Mailing address:
  • Phone: 925-373-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA123350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: