Healthcare Provider Details

I. General information

NPI: 1083559124
Provider Name (Legal Business Name): UNITED BAUDOUIN LEVAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4047 NORMAL ST
SAN DIEGO CA
92103-2617
US

IV. Provider business mailing address

4047 NORMAL ST
SAN DIEGO CA
92103-2617
US

V. Phone/Fax

Practice location:
  • Phone: 760-842-2232
  • Fax:
Mailing address:
  • Phone: 760-842-2232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-MYRPVZ
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: