MEDICARE: MAURICIO LEVINE M.D.

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	174400000X	Specialist	A45582	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407833031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURICIO LEVINE M.D.

Provider Business Mailing Address
First Line	:	765 MEDICAL CENTER CT
Second Line	:	SUITE: 201
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-6600
Country	:	US
Telephone Number	:	619-482-8080
Fax Number	:	619-482-8072

Provider Business Practice Location Address
First Line	:	765 MEDICAL CENTER CT
Second Line	:	SUITE: 201
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-6600
Country	:	US
Telephone Number	:	619-482-8080
Fax Number	:	619-482-8072

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	07/09/2007

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Directions to “ MAURICIO LEVINE M.D.” Practice Location

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