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NPI Code Detail

MEDICARE: GWENDOLYN DIANE LEVY

MEDICARE: GWENDOLYN DIANE LEVY
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
1164X00000XLicensed Vocational NurseVN117837CA

General Provider Information

NPI Number : 1699916064
Entity Type Code : Individual
Provider Name (Legal Business Name) : GWENDOLYN DIANE LEVY
Provider Business Mailing Address
First Line : 2650 E FOOTHILL BLVD
Second Line :
City : PASADENA
State : CA
Zip : 91107-3439
Country : US
Telephone Number : 626-577-2261
Fax Number :
Provider Business Practice Location Address
First Line : 2650 E FOOTHILL BLVD
Second Line :
City : PASADENA
State : CA
Zip : 91107-3439
Country : US
Telephone Number : 626-577-2261
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2009
Last Update Date : 10/22/2020

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Directions to “ GWENDOLYN DIANE LEVY ” Practice Location

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