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General NPI Number Information
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NPI Number | 1881875433
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Entity Type | Organization
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Legal Business Name | PHILLIP LEVINE,M.D A MEDICAL CORP
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Dates
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Enumeration Date | 11/23/2007
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 8631 W 3RD ST #815E
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City | LOS ANGELES
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State | CA
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Zip | 90048-5901
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Country | US
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Telephone | 310-657-3145
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Fax |
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Provider Business Mailing Address
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Address Line | 8631 W 3RD ST #815E
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City | LOS ANGELES
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State | CA
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Zip | 90048-5901
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Country | US
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Telephone | 310-657-3145
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PHILLIP LEVINE
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Credential | MD
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Telephone | 310-657-3145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G35171
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License Number State | CA
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