Provider Demographics
NPI:1134330756
Name:LEVY, DAVID SANFORD (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SANFORD
Last Name:LEVY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4659
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93403-4659
Mailing Address - Country:US
Mailing Address - Phone:805-597-8386
Mailing Address - Fax:
Practice Address - Street 1:10 SANTA ROSA ST
Practice Address - Street 2:STE. 201
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5825
Practice Address - Country:US
Practice Address - Phone:805-544-7246
Practice Address - Fax:805-782-8097
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21787363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical