=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770294415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVEN LEVINE MD A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2022
-----------------------------------------------------
Last Update Date | 12/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 SANTA MONICA BLVD STE 687W
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404-2186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-829-3350
-----------------------------------------------------
Fax | 310-829-3395
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 SANTA MONICA BLVD STE 687W
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404-2186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-829-3350
-----------------------------------------------------
Fax | 310-829-3395
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | DR. STEVEN JAY LEVINE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-829-3350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------