1457598385 NPI number — MARIA LEVISTE MD INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457598385 NPI number — MARIA LEVISTE MD INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIA LEVISTE MD INC.
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:
1457598385
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6150 PASEO LA VIS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91367-1082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-783-9005
Provider Business Mailing Address Fax Number:
818-932-9936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 N PACIFIC AVE
Provider Second Line Business Practice Location Address:
SUITE #103
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91202-3250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-783-9005
Provider Business Practice Location Address Fax Number:
818-932-9936
Provider Enumeration Date:
01/14/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEVISTE
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
818-783-9005

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A39016 , 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)