=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013990936
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL LEBOVITS RPA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2005
-----------------------------------------------------
Last Update Date | 09/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 N UNIVERSITY DR STE K
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33065-5082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-780-8161
-----------------------------------------------------
Fax | 954-755-1865
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 N UNIVERSITY DR STE K
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33065-5082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-780-8161
-----------------------------------------------------
Fax | 954-755-1865
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9114573
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------