1215313523 NPI number — MARK LEVINE M.D. MINDFULNESS ASSOCIATES, P.C.

Table of content: (NPI 1215313523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215313523 NPI number — MARK LEVINE M.D. MINDFULNESS ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK LEVINE M.D. MINDFULNESS ASSOCIATES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215313523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26645 NORMANDY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48025-1033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-241-9496
Provider Business Mailing Address Fax Number:
916-436-9055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3017 DOUGLAS BLVD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-3850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-500-6463
Provider Business Practice Location Address Fax Number:
844-553-6337
Provider Enumeration Date:
08/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LEVINE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
530-902-4976

Provider Taxonomy Codes

  • Taxonomy code: 103TP2701X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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