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General NPI Number Information
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NPI Number | 1689470122
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Entity Type | Organization
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Legal Business Name | RUSS L LEVITAN MD INC
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 10 SANTA ROSA ST # 201
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-5826
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Country | US
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Telephone | 805-544-7246
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Fax | 805-782-8097
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Provider Business Mailing Address
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Address Line | 1305 FILAREE WAY
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-4947
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Country | US
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Telephone | 805-550-0445
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Fax | 805-782-8097
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Authorized Official
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Title or Position | PRESIDENT
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Name | RUSS L LEVITAN
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Credential | MD
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Telephone | 805-550-0445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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