MEDICARE: JENNIFER RAE LEVITT PHYSICIAN ASSISTANT, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1235737172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER RAE LEVITT PHYSICIAN ASSISTANT, INC

Provider Business Mailing Address
First Line	:	6250 HOLLYWOOD BLVD UNIT 5A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5331
Country	:	US
Telephone Number	:	214-455-5366
Fax Number	:

Provider Business Practice Location Address
First Line	:	1439 N HIGHLAND AVE STE 1059
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7622
Country	:	US
Telephone Number	:	323-289-8900
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	JENNIFER R KOSOVA
Credential	:	PA
Telephone Number	:	323-289-8900

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	10/13/2020

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