Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | G65341 | CA |
NPI | 1154493476 |
---|---|
Provider Name | Fred Levine |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123-2771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 09/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G653410 | (05) | CA |