MEDICARE: MRS. SOPHIA ANN LEVER

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1386830321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SOPHIA ANN LEVER

Provider Business Mailing Address
First Line	:	4336 ELK DR
Second Line	:
City	:	ANTIOCH
State	:	CA
Zip	:	94531-7735
Country	:	US
Telephone Number	:	925-778-2871
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ELLINWOOD WAY
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-4817
Country	:	US
Telephone Number	:	925-969-3300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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