Healthcare Provider Details

I. General information

NPI: 1003015744
Provider Name (Legal Business Name): BRETT A. LEVINE, M.D., PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21320 HAWTHORNE BLVD STE 119
TORRANCE CA
90503-5651
US

IV. Provider business mailing address

409 N PACIFIC COAST HWY STE 482
REDONDO BEACH CA
90277-2870
US

V. Phone/Fax

Practice location:
  • Phone: 310-543-2313
  • Fax: 310-944-9295
Mailing address:
  • Phone: 310-543-2313
  • Fax: 310-944-9295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG74806
License Number StateCA

VIII. Authorized Official

Name: DR. BRETT A LEVINE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 310-543-2313