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General NPI Number Information
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NPI Number | 1033734439
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Entity Type | Individual
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Provider Name | JUDE LEGROS LEVASSEUR NP
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Gender | Male
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 19200 VON KARMAN AVE STE 500
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City | IRVINE
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State | CA
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Zip | 92612-8513
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Country | US
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Telephone | 949-382-4776
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Fax |
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Provider Business Mailing Address
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Address Line | 19200 VON KARMAN AVE STE 500
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City | IRVINE
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State | CA
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Zip | 92612-8513
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Country | US
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Telephone | 877-628-3367
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP95014463
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License Number State | CA
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