1154312171 NPI number — DR. STUART HOWARD LEVINE MD

Table of content: DR. STUART HOWARD LEVINE MD (NPI 1154312171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154312171 NPI number — DR. STUART HOWARD LEVINE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVINE
Provider First Name:
STUART
Provider Middle Name:
HOWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEVINE
Provider Other First Name:
STUART
Provider Other Middle Name:
HOWARD
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, MHA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1154312171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 S HELBERTA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDONDO BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90277-4353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-543-1335
Provider Business Mailing Address Fax Number:
310-543-6826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 S HELBERTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDONDO BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90277-4353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-354-4225
Provider Business Practice Location Address Fax Number:
310-543-6826
Provider Enumeration Date:
10/31/2005

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: 2084P0800X , with the licence number:  G57910 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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