Provider Demographics
NPI:1255319406
Name:MOODY LEVIN, SANDRA YVONNE (MD, BSN)
Entity Type:Individual
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First Name:SANDRA
Middle Name:YVONNE
Last Name:MOODY LEVIN
Suffix:
Gender:F
Credentials:MD, BSN
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Mailing Address - Street 1:4150 CLEMENT ST
Mailing Address - Street 2:181G
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1545
Mailing Address - Country:US
Mailing Address - Phone:415-221-4810
Mailing Address - Fax:415-750-6641
Practice Address - Street 1:4150 CLEMENT ST
Practice Address - Street 2:181G
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1545
Practice Address - Country:US
Practice Address - Phone:415-221-4810
Practice Address - Fax:415-750-6641
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2011-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG86022207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G-82165Medicare UPIN