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General NPI Number Information
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NPI Number | 1215780317
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Entity Type | Individual
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Provider Name | MIA LI LEVINE DO
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Gender | Female
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Dates
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Enumeration Date | 04/09/2024
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 3900 SIERRA CIR
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City | CENTER VALLEY
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State | PA
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Zip | 18034-8471
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Country | US
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Telephone | 610-402-2277
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Fax |
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Provider Business Mailing Address
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Address Line | 3350 HAUCK ST APT 2029
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City | LAS VEGAS
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State | NV
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Zip | 89146-8034
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Country | US
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Telephone | 410-562-7877
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | AA0005280020
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License Number State | PA
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