Provider Demographics
NPI:1003949249
Name:LEVINE, MARC D (RPT)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:D
Last Name:LEVINE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:23356 TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1450
Mailing Address - Country:US
Mailing Address - Phone:661-513-9317
Mailing Address - Fax:661-513-9348
Practice Address - Street 1:23356 TIMBERLANE DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-1450
Practice Address - Country:US
Practice Address - Phone:661-513-9317
Practice Address - Fax:661-513-9348
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 16807171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor