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General NPI Number Information
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NPI Number | 1790262590
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Entity Type | Organization
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Legal Business Name | LEVINE FOOT & ANKLE SURGERY
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Dates
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Enumeration Date | 07/24/2018
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 2701 W ALAMEDA AVE STE 401A
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City | BURBANK
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State | CA
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Zip | 91505-4409
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Country | US
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Telephone | 818-450-6656
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Fax | 818-484-2941
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Provider Business Mailing Address
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Address Line | 10061 RIVERSIDE DR # 1049
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City | TOLUCA LAKE
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State | CA
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Zip | 91602-2560
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICK LEVINE
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Credential | DPM
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Telephone | 818-450-6656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | A5360
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License Number State | CA
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