MEDICARE: MR. MARTIN LEVINE CRNA

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	367500000X	Certified Registered Nurse Anesthetist	179367	CA

General Provider Information

NPI Number	:	1942220314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARTIN LEVINE CRNA

Provider Business Mailing Address
First Line	:	556 WOODLAND DR
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-4249
Country	:	US
Telephone Number	:	805-489-3065
Fax Number	:

Provider Business Practice Location Address
First Line	:	556 WOODLAND DR
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-4249
Country	:	US
Telephone Number	:	805-489-3065
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	12/21/2025

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