MEDICARE: DANIEL LEVINE

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	133V00000X	Registered Dietitian	39402-DI-0	NV
2	390200000X	Student in an Organized Health Care Education/Training Program	TL.0011424	CO

General Provider Information

NPI Number	:	1528550480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL LEVINE

Provider Business Mailing Address
First Line	:	12631 E 17TH AVE # B8202
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80045-2527
Country	:	US
Telephone Number	:	303-724-7494
Fax Number	:

Provider Business Practice Location Address
First Line	:	4215 S GRAND CANYON DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7172
Country	:	US
Telephone Number	:	702-664-1204
Fax Number	:

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

Provider Enumeration Date	:	06/05/2018
Last Update Date	:	04/08/2026

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Directions to “ DANIEL LEVINE ” Practice Location

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