Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G74806 | CA |
NPI | 1063413110 |
---|---|
Provider Name | Dr. Brett A Levine |
First Address | Torrance, CA 90503-5606 |
Second Address | Torrance, CA 90503-5606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 17/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G748060 | (05) | CA |
F74957 | (02) | CA |