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General NPI Number Information
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NPI Number | 1235737172
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Entity Type | Organization
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Legal Business Name | JENNIFER RAE LEVITT PHYSICIAN ASSISTANT, INC
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Dates
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Enumeration Date | 10/13/2020
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 1439 N HIGHLAND AVE STE 1059
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City | LOS ANGELES
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State | CA
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Zip | 90028-7622
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Country | US
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Telephone | 323-289-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 6250 HOLLYWOOD BLVD UNIT 5A
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City | LOS ANGELES
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State | CA
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Zip | 90028-5331
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Country | US
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Telephone | 214-455-5366
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | JENNIFER R KOSOVA
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Credential | PA
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Telephone | 323-289-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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