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General NPI Number Information
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NPI Number | 1972753515
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Entity Type | Organization
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Legal Business Name | SERGIO LEVENZON M.D. INC.
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 520 N MAIN ST SUITE 100
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City | SANTA ANA
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State | CA
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Zip | 92701-4623
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Country | US
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Telephone | 714-953-4242
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Fax | 714-953-4366
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Provider Business Mailing Address
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Address Line | 520 N MAIN ST SUITE 100
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City | SANTA ANA
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State | CA
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Zip | 92701-4623
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Country | US
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Telephone | 714-953-4242
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Fax | 714-953-4366
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | SERGIO LEVENZON
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Credential | M.D.
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Telephone | 714-953-4242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A30834
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License Number State | CA
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