Provider Demographics
NPI:1265659924
Name:LEVY, JUDITH SARA (LAC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:SARA
Last Name:LEVY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 I ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4309
Mailing Address - Country:US
Mailing Address - Phone:916-444-1962
Mailing Address - Fax:916-442-2008
Practice Address - Street 1:2701 I ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4309
Practice Address - Country:US
Practice Address - Phone:916-444-1962
Practice Address - Fax:916-442-2008
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4523171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist