Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | NP95014463 | CA |
NPI | 1033734439 |
---|---|
Provider Name | Jude Legros Levasseur |
First Address | Irvine, CA 92612-8513 |
Second Address | Irvine, CA 92612-8513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2020 |
Last Update Date | 02/07/2020 |