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General NPI Number Information
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NPI Number | 1891382198
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Entity Type | Individual
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Provider Name | MADISON CARLY LEVINE NP
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Gender | Female
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Dates
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Enumeration Date | 12/21/2020
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 30300 CAMINO CAPISTRANO
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1304
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Country | US
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Telephone | 949-240-2272
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Fax |
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Provider Business Mailing Address
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Address Line | 811 BUENA VIS APT 6
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-5067
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Country | US
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Telephone | 949-878-8180
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95037704
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License Number State | CA
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