Provider Demographics
NPI:1083059554
Name:LEVIN, JACQUELINE D (BA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:D
Last Name:LEVIN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:D
Other - Last Name:VELICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:14515 HAMLIN ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1608
Mailing Address - Country:US
Mailing Address - Phone:818-374-5383
Mailing Address - Fax:818-374-5388
Practice Address - Street 1:14515 HAMLIN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1608
Practice Address - Country:US
Practice Address - Phone:818-374-5383
Practice Address - Fax:818-374-5388
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner