Provider Demographics
NPI:1255486734
Name:ANTHONY LEVATINO MD LLC
Entity Type:Organization
Organization Name:ANTHONY LEVATINO MD LLC
Other - Org Name:WOMEN'S WELLNESS CENTER OF SOUTHERN NEW MEXICO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LEVATINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-647-8366
Mailing Address - Street 1:PO BOX 1560
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-1560
Mailing Address - Country:US
Mailing Address - Phone:505-647-8366
Mailing Address - Fax:505-647-8381
Practice Address - Street 1:2907 HILLRISE DR
Practice Address - Street 2:# B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4701
Practice Address - Country:US
Practice Address - Phone:505-647-8366
Practice Address - Fax:505-647-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty