1417214198 NPI number — DR. ELIZABETH SEGAL LEVIN

Table of content: DR. ELIZABETH SEGAL LEVIN (NPI 1417214198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417214198 NPI number — DR. ELIZABETH SEGAL LEVIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVIN
Provider First Name:
ELIZABETH
Provider Middle Name:
SEGAL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1417214198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 FRANCIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02115-6110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-732-7537
Provider Business Mailing Address Fax Number:
857-307-0899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UCLA DIVISION OF VASCULAR SURGERY
Provider Second Line Business Practice Location Address:
200 UCLA MEDICAL PLAZA, SUITE 510-6
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-206-5145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  278194 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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