Provider Demographics
NPI:1043368293
Name:P. DAVID LEVIADIN, MD, INC.
Entity Type:Organization
Organization Name:P. DAVID LEVIADIN, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:P.
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LEVIADIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-888-8050
Mailing Address - Street 1:450 N BEDFORD DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4324
Mailing Address - Country:US
Mailing Address - Phone:310-888-8050
Mailing Address - Fax:310-888-8021
Practice Address - Street 1:450 N BEDFORD DR
Practice Address - Street 2:SUITE 304
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4324
Practice Address - Country:US
Practice Address - Phone:310-888-8050
Practice Address - Fax:310-888-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA605152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA60515Medicare ID - Type Unspecified