Healthcare Provider Details

I. General information

NPI: 1265077838
Provider Name (Legal Business Name): MARIA LEVANO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 05/06/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W. COLORADO BLVD. PAVILION II SUITE 933
DALLAS TX
75208
US

IV. Provider business mailing address

221 W. COLORADO BLVD. PAVILION II SUITE 933
DALLAS TX
75208
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-3684
  • Fax: 214-947-3686
Mailing address:
  • Phone: 214-947-3684
  • Fax: 214-947-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13275
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: