Healthcare Provider Details

I. General information

NPI: 1982923462
Provider Name (Legal Business Name): PAULA LEVY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E LOS ANGELES AVE SUITE 210
SIMI VALLEY CA
93065-2033
US

IV. Provider business mailing address

1720 E LOS ANGELES AVE SUITE 210
SIMI VALLEY CA
93065-2033
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-6755
  • Fax:
Mailing address:
  • Phone: 805-527-6755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number26673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: