=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326111832
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA A LEVINSKY M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 06/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3466 MT DIABLO BLVD SUITE C100
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94549-7106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-283-5800
-----------------------------------------------------
Fax | 925-284-8115
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2918 ELMWOOD CT
-----------------------------------------------------
City | BERKELEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94705-2326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-283-5800
-----------------------------------------------------
Fax | 925-284-8115
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G376840
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------