MEDICARE: SERGIO LEVENZON M.D. INC.

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	A30834	CA

General Provider Information

NPI Number	:	1972753515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERGIO LEVENZON M.D. INC.

Provider Business Mailing Address
First Line	:	520 N MAIN ST
Second Line	:	SUITE 100
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4623
Country	:	US
Telephone Number	:	714-953-4242
Fax Number	:	714-953-4366

Provider Business Practice Location Address
First Line	:	520 N MAIN ST
Second Line	:	SUITE 100
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4623
Country	:	US
Telephone Number	:	714-953-4242
Fax Number	:	714-953-4366

Authorized Official
Title or Position	:	PRESIDENT OF CORPORATION
Name	:	SERGIO LEVENZON
Credential	:	M.D.
Telephone Number	:	714-953-4242

Provider Enumeration Date	:	09/19/2008
Last Update Date	:	01/07/2010

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