MEDICARE: DR. NADINE ANNE LEVINSON DDS

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	102L00000X	Psychoanalyst	RP033	CA
2	122300000X	Dentist	D21031	CA

General Provider Information

NPI Number	:	1619188760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NADINE ANNE LEVINSON DDS

Provider Business Mailing Address
First Line	:	30011 IVY GLENN DR STE 105
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-5015
Country	:	US
Telephone Number	:	949-495-3332
Fax Number	:	949-496-0723

Provider Business Practice Location Address
First Line	:	30011 IVY GLENN DR STE 105
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-5015
Country	:	US
Telephone Number	:	949-495-3332
Fax Number	:	949-496-0723

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	03/27/2013

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