Provider Demographics
NPI:1225037336
Name:LEVY, LOUIS JOSEPH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:JOSEPH
Last Name:LEVY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8881 FLETCHER PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3134
Mailing Address - Country:US
Mailing Address - Phone:619-589-6888
Mailing Address - Fax:619-589-6492
Practice Address - Street 1:8881 FLETCHER PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3134
Practice Address - Country:US
Practice Address - Phone:619-589-6888
Practice Address - Fax:619-589-6492
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC37491Medicaid
CAC37491Medicaid